There are several different types of hysterectomy and the procedure can be performed using a variety of methods.
During a partial hysterectomy, your doctor removes only part of your uterus. The surgery leaves your cervix intact.
During a total hysterectomy, your doctor removes your entire uterus, including your cervix. You’ll no longer need to have an annual Pap test for cervical cancer if your cervix is removed. However, you should continue to have regular pelvic exams.
Hysterectomy and salpingo-oophorectomy
With this surgery, your doctor removes your uterus as well as one or both of your ovaries and fallopian tubes. You may need hormone replacement therapy if both of your ovaries are removed, as you can experience symptoms of menopause.
Your gynaecologist removes your whole uterus, tissue on the sides of your uterus, your cervix, and the top part of your vagina. This is generally only done when cancer is present.
A hysterectomy can be performed in several ways:
- Through an incision in your abdomen. This is the most common approach to hysterectomy, accounting for about 65% of all procedures. During an abdominal hysterectomy, your gynaecologist removes your uterus through an incision in your abdomen. The incision may be vertical or horizontal. Both types of incisions tend to heal well and leave little scarring.
- Through your vagina. During a vaginal hysterectomy, your gynaecologist removes your uterus through a small incision inside your vagina. There are no external cuts, so there won’t be any visible scars.
Using keyhole surgery. With a keyhole (laparoscopic) hysterectomy, your gynaecologist makes small incisions in your abdomen, then inserts a laparoscope — a long, thin tube with a light and camera at the tip — to visualise your uterus. Once your gynaecologist sees your uterus, they’ll insert instruments through the other incisions to remove your uterus or sometimes cut your uterus into small pieces, then remove one piece at a time. The procedure can also be performed using robotic surgery. With robotic surgery, miniature robotic arms, controlled by your gynaecologist, are inserted through the incisions. Only a few gynaecologists in Australia are trained in this type of surgery.
Which is the best method?
The best method for you will depend on why you’re having the surgery and other factors, such as your general health, previous surgeries and the experience of your gynaecologist. If you have uterine prolapse, vaginal hysterectomy could be an easier approach compared to opening your abdomen. Vaginal hysterectomy may not be suitable if you have adhesions from previous surgery or a very large uterus.
Women who have minimally invasive keyhole surgery tend to report a better experience than women who have abdominal surgery.
Robotic keyhole surgery doesn’t appear to give a better outcome compared to keyhole surgery performed without robotic assistance — and it will probably cost more because of substantial out-of-pocket costs from your gynaecologist.
Recovery times are quicker for vaginal and keyhole hysterectomy, compared to abdominal hysterectomy. Pain after surgery is also likely to be less for a vaginal or keyhole procedure, compared to an abdominal one.
Sometimes a keyhole hysterectomy turns into open abdominal surgery because your gynaecologist discovers another problem, such as cancer.