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Hysterectomy

Know your options — a guide to minimally invasive procedures (MIP) for hysterectomy

What is a hysterectomy?

During a hysterectomy, your doctor may remove the entire uterus or just part of it. The fallopian tubes (the tubes that connect the ovaries to the uterus) and ovaries may also be removed.

Types of hysterectomy:

• Partial (or supracervical) hysterectomy: The upper part of the uterus is removed. The cervix is left in place.
• Total hysterectomy: The entire uterus and cervix are removed.
• Radical hysterectomy: The uterus, upper part of the vagina, and tissue on both sides of the cervix are removed. This is most often done if you have cancer.

Reasons for needing a hysterectomy

• Fibroids
• Endometriosis
• Uterine Prolapse
• Uterine, Endometrial, and Cervical Cancers
• Abnormal Uterine Bleeding

What happens during MIP for hysterectomy?

There are two types of MIP for hysterectomy. Both use advanced surgical procedures that are less invasive than open procedures. These procedures allow the surgeon to remove the uterus without the large incision required by an open surgery. The surgeon gains access to the abdomen either through the vagina or through small incisions in the abdomen. Both approaches often result in less postoperative pain and quicker recovery.

For most types of MIP, the hospital stay is usually one day, and normal activity can be resumed in about two to six weeks after surgery. Patients who have had MIP for their hysterectomy usually experience less pain and faster return to normal activity than patients who have had a total abdominal hysterectomy (TAH).

Side-by-side comparison

Total abdominal hysterectomy (TAH)	Vaginal hysterectomy (VH)	Laparoscopic hysterectomy
In order to gain access to the inside of the body, surgeons sometimes choose to create a large incision because it provides an open view of the internal organs In this conventional open procedure, the surgeon removes the uterus, including the cervix, through a five-inch abdominal incision. The large incision leaves a visible scar on your abdomen, making the TAH the most invasive of hysterectomy types During a TAH, the tissues of the abdominal wall are stretched apart and the uterus is removed through the incision Recovery time is usually longer and the overall level of discomfort may be greater than following a MIP for a hysterectomy Typically requires a hospital stay of 3 to 5 days. Normal activity can usually resume in 6 weeks For certain conditions or situations, this surgery may be the recommended procedure	A vaginal hysterectomy is performed through an incision made at the top of the vagina Through the incision, the uterus, including the cervix, is separated from the surrounding tissues and then removed through the vagina The vaginal incision is small, heals quickly, and usually doesn’t leave an external scar The abdominal muscles are not stretched, so there’s usually less discomfort after the surgery A vaginal hysterectomy takes 1 to 2 hours and requires a hospital stay of 1 to 3 days; normal activity can usually resume in 4 weeks	The surgeon uses various specialized tools inserted through small, dime-sized incisions in the navel and abdomen As with the vaginal hysterectomy, there is no large abdominal incision Hospital stays and recovery times are typically shorter than those after a total abdominal hysterectomy

Know the risks

As with any surgical procedure, MIP for hysterectomy may present risks. You need to talk to your doctor about whether you are a candidate for MIP for hysterectomy. And remember, serious complications from hysterectomy are rare. The risk for serious complications depends on the reason the surgery is needed and your medical condition and age, as well as on the experience of the surgeon and anesthesiologist. Ask your doctor or surgeon about what to expect after surgery, as well as the risks that may occur with surgery, including:

• Reactions to medications or anesthesia
• Breathing problems
• Bleeding
• Infection
• Injury to blood vessels
• Injury to internal organs
• Blood clots in the veins or lungs
• Death (rare)

Additionally, conventional surgery has a greater potential for:

• Muscle injury
• Post-operative incisional hernia

Is an MIP for hysterectomy right for you?

For some patients, MIP is not an appropriate choice. Your surgeon will help you determine the best choice for you and will consider factors such as:

• Obesity
• History of prior abdominal surgery causing dense scar tissue
• Inability to safely visualize organs
• Bleeding problems during the operation
• Underlying medical conditions

The decision to perform MIP or conventional surgery should be made during a discussion with your surgeon. Sometimes a procedure can start out as MIP, but may have to be converted to conventional open surgery based on the factors listed above.

Talk to your doctor

It's important to talk to your doctor about your care. Use these questions as a guide to help you.

• How long will it take me to recover from having a hysterectomy?
• When will I be able to leave the hospital?
• Will my ovaries or any reproductive organs other than my uterus be removed?
• When I can resume my normal activities, including school, work, exercise, sexual activity and recreation?
• What type of hysterectomy will I have? Is it a total abdominal hysterectomy or a minimally invasive procedure?
• Is there a type of minimally invasive procedure appropriate for my situation?
• Which organs will be removed during my procedure?
• Exactly where, and how big, will the incisions be that are made on my body to perform the surgery?
• I'd like to make sure I am having the least-invasive procedure. Is that possible?
• How many of these procedures have you performed in the last 12 months?

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