Hysterectomy is the surgical removal of the uterus or womb. Women might need a hysterectomy to treat uterine cancer, pelvic prolapse, endometriosis or severe cases of uterine fibroids. In the traditional approach, the surgeon accesses the uterus through a large incision in the abdomen, but an approach through a vaginal incision allows a shorter hospital stay and speedier recovery.
Candidates
According to the Mayo Clinic, not all women are good candidates for vaginal hysterectomy. For women with an extremely enlarged uterus, the abdominal approach is better. Most women with endometriosis or cancer of the uterus or ovaries, for example, need the abdominal approach while women suffering from prolapse or abnormal vaginal bleeding can often benefit from the vaginal approach to hysterectomy.
Advantages
Compared to abdominal hysterectomy, vaginal hysterectomy is faster, less invasive and requires less time in the hospital. Full recovery after vaginal hysterectomy usually occurs within one to two weeks, says the Mayo Clinic. Vaginal hysterectomy does not leave a visible scar and incurs less risk of infection.
Anesthesia
The surgeon can perform a vaginal hysterectomy using general anesthesia to make the patient unconscious throughout the procedure. According to the Mayo Clinic, some women can opt for regional anesthesia for a vaginal hysterectomy. With regional anesthesia, the patient remains aware and awake through the procedure. The anesthesiologist numbs the lower half of the body using an injection of a nerve-blocking drug called a spinal block or epidural block into the outermost part of the spinal cord. Regional anesthesia is less risky than general anesthesia.
Preparation
The patient lies with her feet in stirrups as if for a pelvic exam. The surgical team might clip her pubic hair before or after anesthesia. After anesthesia, the surgeon usually inserts a catheter into the bladder to drain out any urine.
Procedure
After the patient is anesthetized, the surgeon makes an incision through the vagina. Using specialized instruments, she clamps the blood vessels serving the uterus to minimize bleeding and then severs its attachments to the vagina, fallopian tubes and connective tissues. Once the uterus is free the surgeon removes it through the incision in the vagina. In some cases where the uterus is unusually large, the surgeon cuts it into smaller pieces before removing it.
Laparoscopic Surgery
Some women can opt for laparoscopic-assisted vaginal hysterectomy. In this variation of the procedure, the surgeon use a special instrument called a laparoscope inserted through a small abdominal incision to see inside the body while performing the operation. Surgeons often recommend this approach for women who likely have scar tissue on their pelvic organs and might otherwise require traditional abdominal hysterectomy. According to the American Congress of Obstetricians and Gynecologists, compared to regular vaginal hysterectomy, laparoscopic surgery takes longer, increases the risk of injury to the bladder and requires general anesthesia, but allows a clear view of the pelvic organs.
