A hysterectomy is a surgical procedure to remove the uterus and sometimes the ovaries and fallopian tubes as well. Although it is often called a hysterectomy, the medically correct term for removing the uterus, tubes and ovaries is hysterosalpingo-oophorectomy. The Mayo Clinic says that a hysterectomy is one of the most common surgical procedures done in women. As a major surgery, hysterectomy involves some risks and follow-up evaluations.
Abdominal Approach
If your uterus is large, or if the surgeon wants to physically inspect other organs during the procedure, she might recommend an abdominal approach to hysterectomy. Using the traditional abdominal approach, the surgeon makes a single large incision through the wall of the lower abdomen to access the uterus. The incision can run vertically, from just below your navel to the level of the pubic bone, or horizontally across the bikini line. The direction of the incision depends on factors such as the presence of other scars on the abdomen, the reason for the hysterectomy, and the need to look at other organs. With abdominal laparoscopic surgery, the doctor makes a few smaller incisions and inserts special surgical instruments through those access points.
With any surgical procedure, the patient risks a bad reaction to anesthesia, blood loss during or after the procedure, and blood clotting after the procedure. Hysterectomy risks also include possible damage to other organs in the pelvis such as the bladder and urinary tract. Compared to abdominal laparoscopic surgery, the traditional approach using a single large incision incurs a greater risk of post-surgical infection, and healing takes longer--about six to eight weeks, according to the Mayo Clinic.
Vaginal Approach
In the vaginal approach, instead of reaching the uterus through an incision in the abdomen, the surgeon passes special instruments up through the vagina. She makes an incision through the wall of the vagina to reach the uterus, cutting it away from the fallopian tubes and connective tissue before removing it through the vaginal incision. With the vaginal approach, the patient has the option of using regional anesthesia to numb the lower half of the body, rather than using general anesthesia. For patients with risk factors for general anesthesia, this might be a good option.
Compared to the abdominal approach, vaginal hysterectomy allows faster recovery and less hospital time, according to the Mayo Clinic. Patients can expect to stay in the hospital for a day or two following the surgery, and full recovery generally takes one to two weeks.
Total vs. Partial
The Mayo clinic states that surgeons usually perform total hysterectomies, removing the entire uterus, including the cervix, the narrow opening at the bottom of the uterus. If the cervix can be spared, the surgeon could perform a partial or supra-cervical ("above the cervix") hysterectomy.
References
- Mayo Clinic.com: Abdominal hysterectomy
- Mayo Clinic.com: Vaginal hysterectomy
- Primary Care for Women; Phyllis Leppert and Jeffrey Peipert; 2004
