Hysterectomy (part 2)

What are the different ways a hysterectomy can be performed?

Routes of Hysterectomy include:

  • Vaginal.
  • Abdominal.
  • Laparoscopic.
  • Robotic.

What is a vaginal hysterectomy and what are its advantages?

Hysterectomy is performed entirely through the vagina, so that the incision is in the vagina and there are no incisions on the abdomen.

The main advantages of this procedure is quicker recovery, short or no hospital stay, rapid return to normal activity and less pain. This is the least invasive type of hysterectomy and is beneficial for all patients as well as patients with multiple medical conditions who may be considered high risk surgical candidates, the elderly or those who cannot tolerate extended periods of anesthesia.




What is an abdominal hysterectomy and what are its advantages?

In this procedure, the uterus is removed through a single large incision on the abdomen. This is the most invasive type of hysterectomy. It generally is performed in women with gynecologic malignancies like ovarian cancer, women who have extensive abdominal pathology like large fibroids, adhesive disease etc. Due to its invasive nature, patients are normally in the hospital for two or more nights, have slower return to regular activity and generally experience more pain.


What is a laparoscopic and / or robotic hysterectomy and what are the advantages?

In this surgery, the surgeon makes multiple small incisions (four to six) on the abdomen and uses laparoscopic instruments or a robot to perform the hysterectomy. These types of hysterectomies are considered minimally invasive as well. As such, patients recover faster, may go home the day of surgery or stay overnight and generally have less pain compared to an abdominal hysterectomy. The robotic hysterectomy has gained popularity in recent years and the percentage of robotic assisted hysterectomies continues to increase nationwide.


What is a laparoscopic assisted vaginal hysterectomy (LAVH) and what are the advantages?

This is a combination of both the laparoscopic and vaginal routes, so that part of the procedure is done laparoscopically through the abdominal wall and the rest of the procedure is completed through the vagina. This route is advantageous as it allows evaluation of the abdomen and pelvis during surgery. It may help decrease the complexity of surgery especially in women with adhesions, endometriosis or previous surgery. In this surgery the patient has incisions both on the abdomen as well as in the vagina.




What determines the type of hysterectomy I get?

Choice of procedure is in large part determined by reason for hysterectomy, existing pathology, surgeon comfort, need for concurrent procedures and available resources. While the overall trend is towards minimally invasive routes and shortened hospital stays, your surgeon will discuss your options as well as make recommendations, thereby enabling shared decision making.


What are the risks of hysterectomy?

Like all surgical procedures there is risk of bleeding, infection, injury to blood vessels or nerves, injury to neighboring organs, stroke, heart attack and death.

Additional risks include trocar site hematoma – bleeding that occurs underneath the skin at the small incision sites after a laparoscopic or robotic hysterectomy, gas embolus, burns, etc.

Your surgical and anesthesia teams work diligently before, during and after surgery to decrease the occurrence of these risks.

Please note each type of hysterectomy allows the surgeon to take out the fallopian tubes and ovaries as needed. They also allow for other procedures to be performed eg prolapse surgery, slings etc.