Types of hysterectomy
There are different types of hysterectomy. The type performed will depend on the reason for surgery and how much of the womb and surrounding reproductive system can safely be left in place. The main types of hysterectomy are listed below.
This is the most commonly performed operation. It removes the womb and cervix (neck of the womb). A total hysterectomy is normally preferred over a subtotal hysterectomy, as removing the cervix means there is no risk of developing cervical cancer.
The main body of the womb is removed, leaving the cervix (neck of the womb) in place. This is not performed very often. If the cervix is left in place there is still a risk of cervical cancer and cervical smear tests are still required.
Some women are reluctant to have their cervix removed as they wish to keep as much of their reproductive system as possible. If you feel this way, you should talk to your surgeon about any possible risks if you keep your cervix.
Total hysterectomy with bilateral salpingo-oophorectomy
A total hysterectomy with bilateral salpingo-oophorectomy is a hysterectomy that also removes the fallopian tubes (salpingectomy) and the ovaries (oophorectomy).
The National Institute for Health and Clinical Excellence (NICE) recommends that the ovaries should only be removed when there is a significant risk of associated disease, for example, if there is a family history of ovarian cancer. Your surgeon will be able to discuss the benefits and disadvantages of removing your ovaries with you.
This type of hysterectomy is usually performed to remove and treat cancer, when other treatments, such as chemotherapy and radiotherapy, are not suitable or have failed to work. It removes the body of the womb, cervix and surrounding tissues, including the fallopian tubes, part of the vagina, ovaries, lymph glands and fatty tissue.
How a hysterectomy is performed
There are three ways to perform a hysterectomy:
During a vaginal hysterectomy, the womb and cervix are removed through a hole that is made in the top of the vagina. Special surgical instruments are placed into the vagina to remove the womb from the ligaments that hold it in place. After the womb and cervix have been removed, the incision made at the top of the vagina is stitched up. The operation normally takes around one hour to complete.
A vaginal hysterectomy may be performed under a general anaesthetic (where you are unconscious) or a local anaesthetic (where you are numb from the waist down).
A vaginal hysterectomy is normally recommended over an abdominal hysterectomy as it is a less invasive operation, with a shorter stay in hospital. Women tend to recover faster after having a vaginal hysterectomy.
During an abdominal hysterectomy an incision (cut) is made in your abdomen (tummy). The incision is either made along the bikini line (horizontal) or vertically from the belly button (umbilicus) to the bikini line.
A vertical incision is usually made when there are large fibroids in the womb or for some types of cancer.
The womb is removed through the incision, and the incision stitched up. The operation takes about an hour.
An abdominal hysterectomy is performed under a general anaesthetic.
You may be advised to have an abdominal hysterectomy if your womb is enlarged by fibroids or pelvic tumours, as it may not be possible to remove it through the vagina.
Ovaries are not usually removed during a vaginal hysterectomy, so if your ovaries need to be removed an abdominal hysterectomy will be recommended.
Laparoscopic surgery is also known as keyhole surgery. During a laparoscopic hysterectomy a small tube carrying a telescope (laparoscope) with a video camera is inserted through a small cut in the abdomen. This allows a surgeon to see the internal organs. Instruments are then inserted through other small cuts in the abdomen or the vagina to remove the womb, cervix and any other parts of the surrounding reproductive system.
A laparoscopic hysterectomy is usually performed under general anaesthetic.
Laparoscopic hysterectomy is less invasive than an abdominal or vaginal hysterectomy. However, because of the level of skill involved, there is a higher risk of complications during surgery. There is a greater risk of damage to the bladder or ureter (the tube leading from the bladder to the kidney), urinary tract infections (UTIs) and severe bleeding.
Because of the higher risks involved, a laparoscopic hysterectomy is usually only recommended when there are clinical reasons why the other two methods cannot be carried out.