If you have a condition that requires a hysterectomy or removal of the uterus, you’ll likely have many questions for your doctor. Why is it needed? What are the risks and side effects? What is the best type of hysterectomy for me?
“It’s normal to have concerns when you’re facing surgery,” says Tresa Lombardi, MD, an OB-GYN specializing in minimally invasive surgery with Scripps Clinic Rancho Bernardo. “Your doctor will explain the procedure in detail. It’s important to know that whenever possible the least invasive procedure is used.”
During a hysterectomy, the surgeon may remove some or all the uterus and sometimes other parts of the reproductive system.
“Your doctor may recommend a hysterectomy when more conservative treatments, such as medications, have not been able to get your condition under control,” Dr. Lombardi says.
A hysterectomy may be performed to treat:
- Uterine fibroids
- Uterine prolapse
- Abnormal bleeding
- Chronic pelvic pain
- Gynecologic cancer
About 600,000 hysterectomies are performed each year in the United States. It is the second most common surgery that women undergo after C-sections.
Technological advances have improved the way this procedure is performed. Minimally invasive techniques can reduce pain after surgery, minimize complications and lead to a quicker recovery.
There are different types of hysterectomy.
- A partial hysterectomy, also known as supracervical hysterectomy, removes the uterus and leaves the cervix intact.
- A total hysterectomy removes the uterus and cervix. In certain cases, one or both ovaries and fallopian tubes may be removed. Removal of both ovaries can result in premature menopause.
- A radical hysterectomy removes the uterus, cervix and part of the vagina. The ovaries, fallopian tubes, and nearby lymph nodes may also be removed. This procedure may be necessary in certain cases of cancer.
A hysterectomy can be done through the vagina, the abdomen or with laparoscopy.
“The choice will depend on why you are having the surgery, your medical history, and the surgeon’s expertise,” says Dr. Lombardi, who has fellowship training in minimally invasive gynecologic surgery. “Don’t hesitate to ask whether a surgeon has specialized training in less invasive procedures.”
In this procedure, also known as open surgery, the uterus is removed through a large abdominal incision. Sometimes this incision is along the hairline, similar to a C-section incision. Other times, it runs up and down on the abdomen. Drawbacks to this traditional technique include increased pain after surgery, greater risk of complications and longer recovery time.
Open surgery may be recommended if:
- The uterus is very large
- The surgery is being used to treat cancer
- The surgeon wants to check other pelvic organs for signs of disease
In this procedure, the uterus is removed through a small incision inside the vagina, with no abdominal incisions. This minimally invasive technique generally causes fewer complications, less pain, and faster recovery than open procedures. This technique may not be possible with a larger uterus or when the surgeon wishes to evaluate other structures in the abdomen.
In this minimally invasive procedure, several thin instruments and a tiny video camera attached to a telescope are inserted through multiple small incisions in the abdomen. The surgeon can remove the uterus through a vaginal incision, a larger abdominal incision or by breaking it up into small pieces through a small abdominal incision.
This technique leads to fewer complications, less pain and faster recovery compared to an open procedure.
Robotic hysterectomy is a type of laparoscopic surgery that uses a robot. This allows surgeons to perform more complex procedures and finer dissections.
This technique also results in fewer complications, less pain and faster recovery compared to an open procedure. Recovery is essentially the same as traditional laparoscopic surgery.
Hysterectomies are generally safe, but problems can occur as is the case in any necessary surgery. Risks include infection, bleeding, damage to nearby organs (bladder, intestines), reactions to anesthesia and blood clot formation. Complications are more common after an abdominal hysterectomy.
In some cases, a surgeon may begin the procedure using minimally invasive techniques, then discover that scar tissue or other challenges require an abdominal procedure. However, this is not common.
“Be sure to ask how often the surgeon begins the procedure one way but finishes it with open abdominal surgery,” Dr. Lombardi says.
Don’t be embarrassed to ask questions about life after a hysterectomy.
“Some women may feel uncomfortable asking their doctors how the procedure may affect certain parts of their personal life, such as when they can start having sex again and what that’s going to feel like,” says Dr. Lombardi.
“In most cases, you’ll be able to have intercourse six weeks after surgery. Most women won’t have any changes in sexual function. But if you do experience discomfort or bleeding during sex, let your doctor know.”
There are no hard or embarrassing questions, not when it comes to your health, she says.