Hysterectomy, or removal of the uterus, is one of the most common surgical procedures for women in the United States. Approximately 600,000 women undergo a hysterectomy each year, according to 2009 information from the Centers for Disease Control and Prevention. Different types of hysterectomy procedures vary according to what tissues are removed. The choice of hysterectomy procedure depends on the indication for the surgery. Additionally, women may have options regarding different surgical approaches that can affect recovery time and postoperative pain.
Supracervical Hysterectomy
A supracervical hysterectomy involves removal of the body of the uterus, but leaves the mouth of the uterus, or the cervix, in place. Supracervical hysterectomy is an option only for women undergoing the procedure for noncancerous indications such as uterine fibroids or endometriosis. A small percentage of reproductive-age women who undergo a supracervical hysterectomy continue to have monthly bleeding.
Some women opt for supracervical hysterectomy based on the notion that preservation of the cervix may enhance urinary and sexual function. The American Congress of Obstetricians and Gynecologists states, however, that no difference in urinary and sexual function exists between women who undergo supracervical hysterectomy compared to those who have the cervix removed.
Total Hysterectomy
Total hysterectomy involves removal of the uterus, including the cervix. This operation is performed for noncancerous and cancerous conditions. Noncancerous indications include uterine fibroids, endometriosis, protracted uterine bleeding, uterine prolapse and chronic pelvic pain, reports the American Congress of Obstetricians and Gynecologists. Total hysterectomy may also be performed for the treatment of certain types of uterine, cervical and ovarian cancer.
Total Radical Hysterectomy
A total radical hysterectomy involves removal of the uterus, including the cervix, along with the uterine support structures and the upper end of the vagina. This operation is typically performed to treat certain types of cervical cancer. The American Cancer Society states that short-term sexual function may be impaired in women undergoing a total radical hysterectomy, but that most women report resolution of sexual problems within six months after surgery.
Abdominal Hysterectomy
An abdominal hysterectomy involves opening the lower abdominal cavity with a 5 to 7-inch incision to remove the uterus, notes the patient information website WomensHealth.gov. This surgical approach is an option for total or radical hysterectomy. It is used infrequently for supracervical hysterectomy.
Laparoscopic Hysterectomy
A laparoscopic hysterectomy involves the use of narrow fiber-optic instruments to conduct the procedure. Three to four small incisions are typically made in the abdomen to insert the instruments. According to the American Congress of Obstetricians and Gynecologists, operative time is generally longer and recovery time is shorter compared to an abdominal hysterectomy. The laparoscopic approach may be an option for all three types of hysterectomy.
Vaginal Hysterectomy
The uterus is removed through an incision in the vagina with a vaginal hysterectomy. A laparoscope may be used to help guide the surgery. As of 2009, the American Congress of Obstetricians and Gynecologists recommends vaginal hysterectomy as the surgical approach of choice for total hysterectomy for noncancerous indications.
References
- Centers for Disease Control and Prevention: Women's Reproductive Health: Hysterectomy
- American Congress of Obstetricians and Gynecologists: Supracervical Hysterectomy Not Superior to Total Hysterectomy
- American Congress of Obstetricians and Gynecologists: Hysterectomy
- American Cancer Society: Sexuality for Women with Cancer, Radical Hysterectomy
- WomensHealth.gov: Hysterectomy, Frequently Asked Questions
