There are three ways of doing a hysterectomy:
- abdominal hysterectomy,
- vaginal hysterectomy and
- laparoscopic hysterectomy.
All these procedures take place under a general anaesthetic.
Abdominal hysterectomy: an incision is made in the abdomen, usually below the bikini line, and this allows the surgeon to snip the uterus free, and to take it out through the same incision.
Vaginal hysterectomy: this is done through the vagina. The cut is made inside the body at the top of the vagina, and so there is no visible scar. The uterus then comes out through the vagina.
Laparoscopic hysterectomy: this uses a very fine telescope, called a laparoscope, which is inserted into the abdomen through a very small cut in the navel (the technique is sometimes called keyhole surgery). It has a tiny video camera in the end of it. After pumping up the abdomen with carbon dioxide gas, to make more room inside, the surgeon uses the laparoscope to get a close-up, detailed view, as he or she watches a screen which shows what the laparoscope is “seeing”. Two or three further small cuts are made in the abdomen, and fine tubes are inserted into them. They provide narrow channels for other surgical instruments, such as a laser, scissors and forceps, used in the actual operation itself. When the uterus is snipped free, it’s removed through the vagina. Then the surgeon stitches you up again. Some conditions are more suited to one procedure than another. lf your doctor advises one sort, ask him or her why. For example, vaginal hysterectomy is often done in cases of prolapse, because the supporting tissues of the vagina, which are probably weakened, can be repaired more easily at the same time. lf you are having the ovaries removed at the same time as the uterus, then you may have an abdominal hysterectomy, because it’s easier to remove the uterus and ovaries through the abdomen.
An abdominal hysterectomy will also be done if you have very large fibroids or advanced cancer. ln some cases, removing the ovaries as well as the uterus is the best option. This might be the case if you are over 50, if cysts are found at the time the operation is done, or if you are suffering from severe pelvic pain linked with your menstrual cycle. However, removing the ovaries will be discussed with you before your operation, and it will only be done with your consent. Recovery time differs according to how your hysterectomy is done. It may take you less time to recover from a laparoscopic or vaginal hysterectomy and, once home, you’ll find you feel fully recovered after about four weeks. After abdominal hysterectomy, recovery time will be longer and you should be ready to return to a normal life after two to three months.