Hysterectomy is the surgical removal of the uterus. A hysterectomy may be recommended to treat many uterine conditions, such as:
- Heavy menstrual bleeding
- Fibroid tumors
- Pelvic prolapse
In the U.S., doctors perform approximately 600,000 hysterectomies a year, making it the second most common surgery for women.1 While this figure is lower in many other parts of the world, hysterectomy is still a common procedure. Fortunately, there are more choices than ever before for the type of hysterectomy as well as the surgical approach.
Types of Hysterectomy
All hysterectomies involve removal of the uterus but other reproductive organs may or may not also need to be removed. The type of hysterectomy your doctor recommends will depend on your specific condition. Keep in mind, if your hysterectomy involves removing the ovaries and you have not started menopause, removing the ovaries will cause menopause to begin. Your doctor may therefore recommend hormone replacement therapy if your ovaries are removed.
Types of hysterectomy include:
A total hysterectomy refers to the removal of the uterus and the cervix only. This is the most common type of hysterectomy.
Partial or subtotal hysterectomy
A partial hysterectomy is also known as a supracervical hysterectomy. This procedure involves removing the upper part of the uterus, but leaving the cervix intact. The decision to keep the cervix is often based on patient preference.
A radical hysterectomy is the removal of the uterus, the tissue on both sides of the cervix, and the upper part of the vagina. This procedure is most often performed when cancer is present.
When a hysterectomy is performed for cancerous conditions – such as uterine, cervical, or ovarian cancer – the surgeon will remove the cancerous organ and certain lymph nodes. This is often referred to as a lymph node dissection or lymphadenectomy. Lymph nodes will be removed in certain areas based on the location and extent or stage of the cancer.
Your fallopian tubes and ovaries may or may not be removed during your hysterectomy. This will depend on several factors including your condition and age. Removal of the ovaries is called an oophorectomy. Removal of fallopian tubes and ovaries is called a salpingo-oophorectomy.
Approaches to Hysterectomy
Just as there are several types of hysterectomies, there are also several ways your doctor can perform the procedure, including:
The uterus is removed through a large abdominal incision. The majority of hysterectomies are performed using this “open” approach. When both the uterus and cervix are removed, this is known as a TAH – Total Abdominal Hysterectomy. The main limitations of an open hysterectomy are the long incision required and lengthy recovery of 4-6 weeks.2
The uterus is removed through the vagina. There are no abdominal incisions but the surgeon makes a small cut in the vagina to remove the uterus. This approach is often used if the patient’s condition is benign (non-cancerous), limited to the uterus, and the uterus is a normal size. When the uterus and cervix are removed through an incision deep inside the vagina, it is known as a TVH – Total Vaginal Hysterectomy, and is often used to treat pelvic prolapse (falling).
The primary limitation of a vaginal hysterectomy is the surgeon’s limited view of the pelvic organs. This procedure can also be challenging if the patient has severe endometriosis or had prior pelvic surgeries such as a C-section that caused adhesions. Recovery from a vaginal hysterectomy can take 3-4 weeks.2
The uterus is removed minimally invasively using instruments inserted through a few small incisions in the abdomen. One of the instruments is an endoscope – a narrow tube with a tiny camera – which allows the surgeon to see the target anatomy on a 2D monitor. When only the uterus is removed, the procedure is called LSH – Laparoscopic Supracervical Hysterectomy. When the uterus and cervix are removed, this is known as TLH – Total Laparoscopic Hysterectomy.
Laparoscopic hysterectomy can be challenging during complex procedures because of the long-handled, rigid instruments used, and recovery can take 3-4 weeks.2
da Vinci Hysterectomy
Fortunately, there is a minimally invasive option for treating gynecologic conditions designed to overcome the limitations of traditional surgery - da Vinci Surgery.
If your doctor recommends a hysterectomy to treat your condition, you may be a candidate for da Vinci Surgery. Using state-of-the-art technology, a da Vinci® Hysterectomy requires only a few tiny incisions, so you can get back to your life faster.
The da Vinci Systemenables your doctor to perform a minimally invasive hysterectomy even for complex conditions with enhanced vision, precision, dexterity and control. da Vinci offers women many potential benefits over traditional surgery, including:
- Less pain3
- Fewer complications4
- Less blood loss5,6
- Shorter hospital stay6
- Low risk of wound infection7
- Quicker recovery and return to normal activities8
The da Vinci System is a state-of-the-art surgical platform with 3D, high-definition vision and miniaturized, wristed surgical instruments designed to help doctors take surgery beyond the limits of the human hand. By helping doctors to overcome the challenges of traditional open and laparoscopic surgery, da Vinci is changing the experience of surgery for women around the world.
If you have been told you need a hysterectomy, it's time to ask your doctor about da Vinci Surgery.
As with any surgery, these benefits cannot be guaranteed since surgery is specific to each patient, condition and procedure. It is important to talk to your doctor about all treatment options, including the risks and benefits. This information can help you to make the best decision for your situation.
- Centers for Disease Control and Prevention. “Women’s Reproductive Health – Hysterectomy Fast Sheet”. Available from: http://www.cdc.gov/reproductivehealth/womensrh/00-04-FS_Hysterectomy.htm
- National Institutes of Health., A Service of the U.S. National Library of Medicine. “Hysterectomy”. Available from: http://www.nlm.nih.gov/medlineplus/ency/article/002915.htm.
- Ko EM, Muto MG, Berkowitz RS, Feltmate CM.Robotic versus open radical hysterectomy: a comparative study at a single institution. Gynecol Oncol. 2008 Dec;111(3):425-30. Epub 2008 Oct 16.
- Piquion-Joseph JM, Navar A, Ghazaryan A, Papanna R, Klimek W, Laroia R. Robot-assisted gynecological surgery in a community setting. Journal of Robotic Surgery, 2009:1-4.
- DeNardis SA, Holloway RW, Bigsby GE, Pikaart DP, Ahmad S, and Finkler NJ. Robotically assisted laparoscopic hysterectomy versus total abdominal hysterectomy and lymphadenectomy for endometrial cancer. Gynecologic Oncology 2008;111:412-417.
- Payne, T. N. and F. R. Dauterive. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol, 2008;15(3): 286-291./li>
- Boggess JF, Gehrig PA, Cantrell L, Shafer A, Ridgway M, Skinner EN, Fowler WC. A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am J Obstet Gynecol. 2008 Oct;199(4):360.e1-9.
- Bell MC, Torgerson J, Seshadri-Kreaden U, Suttle AW, Hunt S. Comparison of outcomes and cost for endometrial cancer staging via traditional laparotomy, standard laparoscopy and robotic techniques. Gynecol Oncol. 2008 Dec;111(3):407-11. Epub 2008 Oct 1.
While clinical studies support the effectiveness of the da Vinci Surgical System when used in minimally invasive surgery, individual results may vary. There are no guarantees of outcome. All surgeries involve the risk of major complications. Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks of each treatment can help you make the best decision for your individual situation. Surgery with the da Vinci Surgical System may not be appropriate for every individual; it may not be applicable to your condition. Always ask your doctor about all treatment options, as well as their risks and benefits. Only your doctor can determine whether da Vinci Surgery is appropriate for your situation. The clinical information and opinions, including any inaccuracies expressed in this material by patients or doctor about da Vinci Surgery are not necessarily those of Intuitive Surgical, Inc. and should not be considered as substitute for medical advice provided by your doctor. All persons depicted are models unless otherwise noted. © 2012 Intuitive Surgical. All rights reserved. Intuitive, Intuitive Surgical, da Vinci, da Vinci S, da Vinci Si, Single-Site, InSite, TilePro and EndoWrist are trademarks or registered trademarks of Intuitive Surgical. All other product names are trademarks or registered trademarks of their respective holders.