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An estimated 600,000 hysterectomies are performed in the United States each year, making them one of the most common surgeries among women. If it is determined that you would benefit from a hysterectomy,your physician will discuss the various surgical options with you to determine the best course of treatment and whether your condition necessitates the removal of the uterus (hysterectomy) or your ovaries (oophorectomy).
There are four types of hysterectomy procedures:
- Partial or supracervical hysterectomy. The cervix (lower end of the uterus) is left intact and only the upper part of the uterus is removed. Since the cervix remains intact, the potential for cervical cancer remains and regular pap screenings will still be required
- Complete or total hysterectomy. This is the most common type of procedure which involves the entire removal of the uterus, including the cervix although there is no research to suggest that this is the optimal procedure.
- Hysterectomy with bilateral salpingo-oophorectomy. This is a hysterectomy (either partial or complete) plus the removal of the ovaries and fallopian tubes. Reasons for removing ovaries and tubes should be discussed with your doctor. Surgeons do not necessarily remove normal ovaries at time of hysterectomy. Ask your doctor about the best way to treat the symptoms of menopause, which may occur if ovaries are removed in younger women.
- Radical hysterectomy. The removal of the cervix, the uterus, the upper part of the vagina and supporting tissues, including the lymph nodes and is usually performed when cervical cancer is involved. For this procedure, the surgery would be scheduled with a gynecologic oncologist.
There are multiple ways for a physician to perform a hysterectomy, some of which may result in less bleeding and a faster recovery. Your physician will work with you to determine the best course of treatment, taking into consideration your condition and overall general health. These choices may include:
- An “open” or “traditional” hysterectomy. This surgery is similar to a cesarean section. With this approach, a 4-inch incision is made to the abdomen in order to remove the uterus.
- A vaginal hysterectomy. A technique where the uterus and cervix are removed through the vagina. Though the procedure requires greater skill on the part of the surgeon, the technique is less invasive which typically means the patient will experience less scarring and a shorter recovery period.
- Laparoscopic hysterectomy. In this procedure, the physician will use specialized tools which are inserted through fingernail-size incisions in the abdomen. This approach may result in a much faster recovery, typically with much less pain than a traditional hysterectomy. Laparoscopic hysterectomy may also result in less scarring inside the abdomen and pelvis. Advanced laparoscopic skills are required to perform a laparoscopic hysterectomy and all of our team members are trained and experienced in this procedure. Laparoscopic hysterectomy can be performed in conjunction with other pelvic floor surgeries for uterine prolapse and incontinence, such as a laparoscopic sacrocolpopexies or rectopexies for faster recuperation. Another benefit of a laparoscopic hysterectomy is that it allows your surgeon to evaluate your abdomen for scar tissue from previous surgeries, determine if there are physiological reasons for chronic pelvic pain and determine if you have any ovarian cysts that need to be drained, all of which can may prevent a second procedure in the future.