Hysterectomy

A hysterectomy is the surgical removal of the uterus. Your doctor may recommend a hysterectomy for many reasons, such as the treatment of benign precancers, cancerous conditions or chronic pain.

Hysterectomies can be performed in a number of different ways, including:

• Laparoscopic-assisted vaginal hysterectomy (LAVH)—This minimally invasive option involves an incision deep inside the vagina and incisions in the abdomen. Using the tiny camera in the laparoscope as a guide, your surgeon will remove the uterus through your vagina. This may not be an option if your uterus is too large to be safely removed through the vagina.
• Total laparoscopic hysterectomy (TLH)—This minimally invasive procedure requires small incisions in the abdomen. Laparoscopic surgical tools are then inserted into the abdomen to remove the uterus. This method allows for a minimally invasive approach even if your uterus is too large to exit the vagina.
• Vaginal hysterectomy—This method involves the surgeon removing the uterus entirely through your vagina. It does not require any incisions, but cannot be done if your uterus is too large to be safely removed through the vagina.
• Robotic hysterectomy—Your surgeon will operate a robot to conduct this minimally invasive method. By making small incisions in the abdomen, your surgeon can remove your uterus through the small tube-shaped instruments.
• Single incision hysterectomy—By making one incision in the belly button, your surgeon can remove your uterus through the single incision with special laparoscopic or robotic equipment. This method reduces pain and scarring.
• Abdominal hysterectomy—This open surgical method requires a large vertical or horizontal incision. This method results in larger scars and a longer recovery time, but may be necessary in cases complicated by a large uterus, a high number of fibroids or cancer that has spread to other areas of the pelvic region.

Before your procedure, your gynecologic oncologist will explain what your options are, and what the best course of action is and why.

If you have not yet experienced menopause, your hysterectomy will end menstruation. You will also no longer be able to become pregnant because the uterus is where the fetus develops.

If you are referred to Northwell Health’s Division of Minimally Invasive and Robotic Gynecologic Surgery for a hysterectomy, you will be cared for by surgeons with expertise in the latest minimally invasive techniques, including robotic and single-incision surgery.

Because of the proven success of our experienced surgeons, several of our hospitals have been designated as a Center of Excellence in Minimally Invasive Gynecologic Surgery (COEMIG) by the American Association of Gynecologic Laparoscopists and the Surgical Review Corporation.

Being told you need a hysterectomy can be a difficult experience, but you can count on our surgeons to offer the safest treatment plan that allows you to get back to being you as soon as possible.

Hysterectomies fall into two main categories:

• Total hysterectomy—This is the most common hysterectomy. It involves the removal of the entire uterus and the cervix.
• Subtotal hysterectomy—Also known as a partial hysterectomy, a subtotal hysterectomy is the removal of the uterus while keeping the cervix in place.

Your specialist will make a recommendation on which type of hysterectomy is the safest option for you and answer any questions you or your loved ones have.

There are a wide variety of reasons why your physician may have recommended a hysterectomy. They can be used to treat benign precancers and cancerous conditions, symptoms such as bleeding or abdominal pain, or a malignancy. They may also be used to reduce the risk of developing cancer.

Some of the more common reasons for undergoing a hysterectomy include:

• Cervical cancer—Typically caused by the human papillomavirus, it occurs when cells on the cervix begin growing at an abnormal rate. It is often diagnosed with a Pap test.
• Endometrial cancer—Affects the lining inside the uterus, called the endometrium. Also referred to as uterine cancer, endometrial cancer is often detected by abnormal vaginal bleeding.
• Endometriosis—Occurs when the tissue lining the inside of the uterus, called the endometrium, grows beyond the uterus. Feeling severe pain during your period may be a sign of endometriosis.
• Fibroids—These account for a significant number of hysterectomies. They are a common condition characterized by tumors that develop in the female reproductive system. Most fibroids are noncancerous.
• Menorrhagia—This is a common condition characterized by abnormal and/or heavy bleeding during your period.
• Ovarian cancer—Cancer that originates in the ovaries. It is difficult to diagnosis and is often discovered in late stages.
• Pelvic floor disorders—These occur when the pelvic floor, made up of muscles, ligaments and tissues, is damaged or weakened and begins to drop under the weight of the organs it supports.
• Pelvic organ prolapse—A condition caused by a pelvic organ dropping and putting pressure on your vaginal walls. Pelvic organs, such as the bladder, can begin dropping when the muscles that keep them stable are weakened by natural or surgical causes.

All major surgeries are associated with risks and hysterectomies are no different. Some of the most common risks include:

• Heavy bleeding
• Blood clots
• Infection
• Damage to nearby organs, such as the bowels or bladder
• Menopause

The risk factors of a hysterectomy vary with each individual, and some risks may be more or less concerning to you than others. It is important to have a conversation about these risks with your surgeon so that you fully understand the long-term effects a hysterectomy may have on you.

Prior to undergoing a hysterectomy, your surgeon will provide you with a detailed list of steps to prepare for the surgery. Preparation may vary from surgeon to surgeon, but the preparation process commonly includes:

• Tests to make sure surgery is a safe option for you
• No eating or drinking after midnight the night before surgery
• Stopping certain medications

The type of hysterectomy and reason for it will have an effect on what you can expect after surgery. Your physician will explain what you should expect after your procedure, and what symptoms are normal and abnormal during the recovery process.

Some of the common aspects of recovery include:

• Hospitalization for one to five days depending on the method of surgery
• A need for walking around once strength is regained to avoid blood clots
• Limited activities for four to six weeks
• Drainage from the vagina that may appear bloody or brown
• A follow up appoint within six weeks