There are many reasons why a hysterectomy may be needed. Discuss the procedure with your surgeon to understand which type of hysterectomy you are having.
A hysterectomy will be performed as an inpatient procedure requiring a hospital stay and a recovery period at home.
A total hysterectomy, sometimes called a simple hysterectomy, removes the entire uterus and the cervix as part of cervical cancer treatment. The ovaries are not removed and continue to secrete hormones.
In addition to a total hysterectomy, a procedure called a bilateral salpingo-oophorectomy is sometimes performed. This surgery removes the ovaries and the fallopian tubes. Removal of the ovaries eliminates the main source of the hormone estrogen, so menopause occurs immediately.
A radical hysterectomy removes the uterus, cervix, upper part of the vagina, ovaries, fallopian tubes, lymph nodes, lymph channels, and tissue in the pelvic cavity that surrounds the cervix. This type of hysterectomy removes the most tissue and requires the longest hospital stay and a longer recovery period.
About 3/4th of hysterectomies are performed abdominally. The surgeon makes a 4–6-in (10–15-cm) incision either horizontally across the pubic hair line from hip bone to hip bone or vertically from navel to pubic bone. Horizontal incisions leave a less noticeable scar, but vertical incisions give the surgeon a better view of the abdominal cavity. The blood vessels, fallopian tubes, and ligaments are cut away from the uterus. The uterus is lifted out.
Abdominal hysterectomies take from one to three hours. The hospital stay is three to five days, and it takes four to eight weeks to return to normal activities.
With a vaginal hysterectomy, the surgeon makes an incision near the top of the vagina. The surgeon then reaches through this incision to cut and tie off the ligaments, blood vessels, and fallopian tubes. Once the uterus is cut free, it is removed through the vagina.
The operation takes one to two hours. The hospital stay is usually one to three days, and the return to normal activities takes about four weeks.
Minimally invasive hysterectomies
A minimally invasive technique, called laparoscopic surgery, allows the surgeon to perform more complicated hysterectomies vaginally. With this surgery, a tube containing a tiny camera is inserted through an incision in the navel. This allows the surgeon to see the uterus on a video monitor. The surgeon then inserts two slender instruments through small incisions in the abdomen and uses them to cut and tie off the blood vessels, fallopian tubes, and ligaments. When the uterus is detached, it is removed though a small incision at the top of the vagina.
The hospital stay is usually only one day. Recovery time is about two weeks.
What to expect after surgery
The length of time you'll spend in the hospital varies depending on your overall health and the type of hysterectomy you have. In general, you'll can expect:
- Vaginal hysterectomies: 2 days
- Laparoscopic-assisted vaginal hysterectomies: 1 day
- Simple hysterectomy: 1-3 days
- Radical hysterectomy and abdominal hysterectomy with both ovaries removed: 5-6 days
Return to normal activities such as driving and working takes anywhere from two to eight weeks, again, depending on the type of surgery.