Hysterectomy

A hysterectomy is the surgical removal of a woman's uterus. In some cases, the ovaries and fallopian tubes are also removed; this procedure is called an oophorectomy.

See also: Laparoscopic Surgery, including the Supracervical Hysterectomy (LSH) video

Each year about 600,000 women in the United States have a hysterectomy. While it continues to be the second most common surgical procedure performed in the United States, this number is declining. Because women now have more treatment choices for reproductive system (gynecologic) conditions, hysterectomy can sometimes be avoided. 1

Hysterectomy Options

Type Incision Site Avg. Hospital Stay Avg. Recovery Time
Laparoscopic Supracervical (LSH) Tiny incisions in abdomen / navel 1 day or less 6 days
TLH Tiny incisions in abdomen / navel 1 day or less 3 weeks
Vaginal Vagina 1-3 days 4 weeks
Laparoscopic-assisted Vaginal (LAVH) Vagina/navel tiny incisions in abdomen 1-3 days 4 weeks
Total Abdominal Abdomen (4-6 inch incision) 5-6 days 6 weeks
Many working women have scheduled their hysterectomies on Thursday or Friday and been back in their office in a week. There is no hospital stay involved with LSH.

What problems do hysterectomies treat?

Hysterectomy is most commonly used as a last-resort treatment for abnormally heavy menstrual bleeding, uterine fibroids, and endometriosis or adenomyosis that doesn't respond to other treatments. Hysterectomy is also used to treat some cases of uterine prolapse and chronic pelvic pain.

In a relatively small number of women, hysterectomy is a potentially lifesaving measure used to stop heavy placental bleeding during childbirth or to remove cervical cancer or endometrial (uterine) cancer. 2 A hysterectomy is also often combined with removal of the ovaries and fallopian tubes (oophorectomy) to treat ovarian cancer and conditions that are made worse by the ovaries' estrogen (such as endometriosis).

Hysterectomies often meant big incisions and often months of recovery for our mothers and grandmothers. But today’s woman has the wonderful alternative of this one hour procedure, requiring just three small 1- to 1.5 inch abdominal incisions. A tiny video camera is inserted and broadcasts an image of the inside of the woman’s body. The doctor operates viewing the enlarged image on a computer monitor.

Special instruments permit removal of a massive fibroid uterus, endometriosis, ovaries, and fallopian tubes through the tiny incisions. After the procedure, three Band Aides are applied to the tummy incisions. A little recovery time, and then it’s voila! The patient is home in just a few hours. A week later she has a follow-up visit with Dr. Chapman who gives her the OK to return to work.

Special training and delicate skills are required. “I had to become ambidextrous; it’s a blessing I work well with both hands,” says Dr. Chapman. As his LSH patients know, Dr. Chapman is extremely skilled! And the patients who’ve had LSH are even surprised by their rapid recovery.

LSH is safe and effective, according to Dr. Chapman. “If there’s no risk of cervical cancer, we’re able to leave the cervix intact, to continue providing anatomic support,” he explains. “For a busy professional, LSH a modern miracle because she is spared the inconvenience of missing work.”

What procedures are used for a hysterectomy?

LSH is performed by inserting a laparoscope and surgical instruments through several small abdominal incisions. The uterus is removed in small pieces, and the cervix is left in place (this can be done when cervical cancer is not present).

Leaving the cervix may help support other internal organs that might otherwise drop lower into the pelvis, possibly preventing sexual and urinary problems after hysterectomy. Further research is necessary to show whether leaving the cervix intact offers a true long-term advantage over removing the cervix. 3

Laparoscopically assisted vaginal hysterectomy (LAVH) is performed through both the vagina and one or more small abdominal incisions. A lighted viewing instrument (laparoscope) and surgical instruments are inserted through one or more small abdominal incisions. The uterus can first be freed from scar tissue through the incision(s) and is then removed through the vagina.

Abdominal hysterectomy is performed through an abdominal incision, giving the surgeon the greatest possible access to the pelvic organs. This is necessary when severe endometriosis, extensive scar tissue (adhesions), or a very large uterus make the uterus difficult to remove, or when cancer might be present.

A vaginal hysterectomy is performed through the vaginal opening, rather than through an abdominal incision. Vaginal hysterectomy is an option when a uterus can be easily removed and when cancer is not a concern.

The hysterectomy procedure you have depends on the medical reason for the hysterectomy, the size and position of your uterus, and your general state of health.

What is removed during a hysterectomy?

It depends. There are several different types of hysterectomies: subtotal, total, and radical. Here are the differences:

Subtotal (partial), removing only the uterus. A partial hysterectomy—also called a supracervical hysterectomy—leaves the cervix in place. After a subtotal hysterectomy, you will continue to have regular Pap smears of your cervix (this type of hysterectomy is not an option when cervical cancer is a concern).

Total (complete), removal of the uterus and cervix.

Radical, removal of the uterus, cervix, ovaries, structures that support the uterus, and sometimes the lymph nodes as well. A radical hysterectomy may be done to treat endometriosis or cancer of the uterus or cervix.

During a hysterectomy, other organs can be removed or repairs can be made to other organs or structures in the pelvic area. These procedures may include: Removal of the fallopian tubes and ovaries (oophorectomy).

What is robotic-assisted surgery?

Robotic-assisted surgery, a type of minimally invasive surgery (MIS), uses surgical robotic equipment, which imitates surgical movements. MIS procedures allow surgeons to operate through small ports rather than large incisions, resulting in shorter recovery times, fewer complications and reduced hospital stays. Surgical robotics combines minimally advanced surgery with highly advanced clinical technology.

How does robotic-assisted surgery work?

The computer-enhanced minimally invasive surgical system consists of three components that provide:

  1. A 3-D view of the surgical field, including depth of field, magnification and high resolution
  2. instruments that are designed to mimic the movement of the human hands, wrists and fingers, allowing an extensive range of motion and more precision
  3. master controls that allow the surgeon to manipulate the instruments, translating the surgeon’s natural hand and wrist movements into corresponding, precise and scaled movements

How does the new technology assist the surgeon?

The three-dimensional vision system magnifies the surgical field up to 15 times and improves the ability of the surgeon to recognize and control small blood vessels, thereby reducing blood loss.

Surgeons are able to perform minimally invasive procedures with more precision. Robot arms remain steady at all times and robot wrists make it easier for surgeons to manipulate tissue and work from all kinds of angles – positions surgeons would have difficulty getting to otherwise.

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