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Hysterectomy - Comparison of Hysterectomy Procedures

There are several different hysterectomy procedures, each with advantages and disadvantages. Depending on your reason for considering a hysterectomy, you may have a choice between two or more procedures. For complicated or cancer-related conditions that require maximum access and careful examination, your doctor will likely recommend an abdominal hysterectomy.

Vaginal hysterectomy

This type of hysterectomy is done through a small incision (cut) in the vagina, rather than through an abdominal incision. The ovaries and other organs may also be removed. Vaginal hysterectomy tends to cause less pain, and takes less healing time than abdominal hysterectomy. A vaginal hysterectomy can be done:

  • To remove small uterine fibroids.
  • When the uterus is of normal size or slightly enlarged.
  • When endometriosis growths (implants) are not present.
  • When there is no significant scarring in the pelvis from previous surgeries.

Vaginal hysterectomy requires more specialized surgical skill than an abdominal hysterectomy. It can pose a higher risk of injury to other organs. Vaginal hysterectomy is not used when there is a question about possible cancer in the uterus, cervix, or ovaries.

Abdominal hysterectomy

This type of hysterectomy is done through a larger abdominal incision, giving the surgeon the best possible access to the pelvic organs. The cervix may be removed with the uterus (total hysterectomy) or left in place (subtotal hysterectomy). The ovaries and other organs may also be removed. An abdominal hysterectomy is typically done when:

  • The uterus is very large.
  • Uterine fibroids are larger than 8 in. (20 cm) across or located around blood vessels.
  • Cancer of the uterus, ovaries, or cervix is possible.
  • An ovarian growth (mass) is suspected but can't be diagnosed on ultrasound.
  • There is significant scarring or severe endometriosis in the pelvic area.

If a hysterectomy is chosen to treat endometriosis, an abdominal hysterectomy is usually required. One example is when endometriosis growths (implants) or scar tissue (adhesions) must be removed to restore the function of other organs.

Laparoscopically assisted vaginal hysterectomy (LAVH)

Laparoscopic hysterectomy is done with a viewing instrument (laparoscope) and surgical instruments inserted through a vaginal incision and one or more small abdominal incisions. The ovaries and other organs may also be removed. The uterus is removed through the vagina. It is done:

  • When uterine fibroids are small to moderate in size.
  • When the uterus is slightly larger than normal.
  • To remove endometriosis and scar tissue (adhesions) confined to the uterus, fallopian tubes, and ovaries.
  • To assess or remove ovaries at the same time as a vaginal hysterectomy.

LAVH requires the surgeon to have specialized training.

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