There are several approaches to hysterectomy, which your surgeon takes depends on several factors including the underlying condition being treated (heavy bleeding, PMDD, fibroids, endometriosis, cancer or pre-cancer), your anatomy (if you have an enlarged uterus, your weight) and previous surgeries (previous abdominal surgery, cesarean birth). Each has its advantages and disadvantages. You may have a choice, but ultimately the surgeon will decide the most appropriate surgery for you.
An Abdominal or Open Hysterectomy is the most invasive surgery. Most often done with a bikini line cut just above the pubic hairline, it can also be done with a vertical incision with a cut from the naval to just above the hairline. As the incision is larger, the recovery time is much longer with an Abdominal Hysterectomy.
You will need an Abdominal Hysterectomy if you have cancer, or pre-cancerous cells, so that the surgeon has good access to the abdominal cavity and can perform extensive exploration to check for any suspicious lesions or cancer spread. Large fibroids, endometriosis or extensive adhesions from previous surgeries are other instances when you might need an open procedure.
Advantages of Abdominal Hysterectomy
Advantages of an Abdominal Hysterectomy include a lower risk of damage to the urinary tract and blood vessels.
Disadvantages of Abdominal Hysterectomy
Disadvantages are the longer recovery time and much more post operative pain.
A Vaginal Hysterectomy involves and incision made in the upper vagina and removing the uterus through the vagina. The uterus, cervix, Fallopian tubes and ovaries may also be removed through the vagina.
Advantages of a Vaginal Hysterectomy
Advantages of a Vaginal Hysterectomy include considerably less post operative pain, shorter hospital stay, a much faster recovery time, and no visible scar.
Disadvantages of a Vaginal Hysterectomy
A Vaginal Hysterectomy does require more specialised skills on the part of the surgeon, and it can pose a higher risk to the of injury to the urinary tract or other pelvic organs.
Laporascopic Assisted Vaginal Hysterectomy (LAVH)
The use of a laporascopic (lighted scope) that is inserted through one or more small incisions in the abdomen can assist with a vaginal hysterectomy, given the surgeon a better view of the abdominal cavity via a video screen. It is a more specialised procedure, however, and requires more skill on the part of the surgeon than an abdominal hysterectomy.
A laparoscopy hysterectomy can be performed provided the uterus is not enlarged, and any fibroids are small to moderate. The ovaries can be examined and/or also removed this way.
Advantages of LAVH
Advantages are a shorter recovery time, with only small incisions that heal much more quickly than an open procedure.
Disadvantages of LAVH
Disadvantages include potentially a longer surgery, and a higher risk of damage to the urinary tract.
Laporascopic Hysterectomy (LH)
A Laporascopic Hysterectomy is done by inserting a laporascope via two or three small incisions in the lower abdomen, and the uterus is cut into small pieces and removed. The cervix may be removed (total) or left in place (supracervical or subtotal) left in place.
This procedure requires specialised training and not all surgeons can perform it. It is important to check your surgeons credentials and experience thoroughly. Some doctors offer robot assisted surgery, but this is only available in select areas.
Advantages of Laporascopic Hysterectomy
Advantages are again a shorter recovery time, and shorter say in hospital, and usually considerably less pain post-op. Women can return to usual activities in two weeks, as opposed to up to six weeks with an abdominal hysterectomy.
Disadvantages of Laporascropic Hysterectomy
Disadvantages are a longer surgery time, and the procedure is not appropriate if there is a chance of uterine cancer.
While hysterectomy is a very common procedure there are risks of hysterectomy. It is important to discuss all the options thoroughly with your surgeon, including should I have my cervix removed and should I have my ovaries removed.