How a hysterectomy is performed
There are different types of hysterectomy. The operation you have will depend on the reason for surgery and how much of your womb and reproductive system can safely be left in place.
The main types of hysterectomy are described below.
During a total hysterectomy, your womb and cervix (neck of the womb) is removed.
A total hysterectomy is usually the preferred option over a subtotal hysterectomy, because removing the cervix means there's no risk of you developing cervical cancer at a later date.
A subtotal hysterectomy involves removing the main body of the womb and leaving the cervix in place.
This procedure isn't performed very often. If the cervix is left in place, there's still a risk of cervical cancer developing and regular cervical screening will still be needed.
Some women want to keep as much of their reproductive system as possible, including their cervix. If you feel this way, talk to your surgeon about any risks associated with keeping your cervix.
Total hysterectomy with bilateral salpingo-oophorectomy
A total hysterectomy with bilateral salpingo-oophorectomy is a hysterectomy that also involves removing:
- the fallopian tubes (salpingectomy)
- the ovaries (oophorectomy)
The National Institute for Health and Care Excellence (NICE) recommends that the ovaries should only be removed if there's a significant risk of further problems – for example, if there's a family history of ovarian cancer.
Your surgeon can discuss the pros and cons of removing your ovaries with you.
A radical hysterectomy is usually carried out to remove and treat cancer when other treatments such as chemotherapy and radiotherapy aren't suitable or haven't worked.
During the procedure, the body of your womb and cervix is removed, along with:
- your fallopian tubes
- part of your vagina
- lymph glands
- fatty tissue
Performing a hysterectomy
There are three ways a hysterectomy can be performed. These are:
- vaginal hysterectomy
- abdominal hysterectomy
- laparoscopic hysterectomy
During a vaginal hysterectomy, the womb and cervix are removed through an incision that's made in the top of the vagina.
Special surgical instruments are inserted into the vagina to detach the womb from the ligaments that hold it in place.
After the womb and cervix have been removed, the incision will be sewn up. The operation usually takes about an hour to complete.
A vaginal hysterectomy can either be carried out using:
- general anaesthetic – where you'll be unconscious during the procedure
- local anaesthetic – where you'll be awake, but won't feel any pain
- spinal anaesthetic – where you'll be numb from the waist down
A vaginal hysterectomy is usually preferred over an abdominal hysterectomy, because it's less invasive and involves a shorter stay in hospital. The recovery time also tends to be quicker.
During an abdominal hysterectomy, an incision will be made in your abdomen (tummy). It will either be made horizontally along your bikini line, or vertically from your belly button to your bikini line.
A vertical incision will usually be used if there are large fibroids (non-cancerous growths) in your womb, or for some types of cancer.
After your womb has been removed, the incision is stitched up. The operation takes about an hour to perform and a general anaesthetic is used.
An abdominal hysterectomy may be recommended if your womb is enlarged by fibroids or pelvic tumours and it's not possible to remove it through your vagina.
It may also be recommended if your ovaries need to be removed.
Laparoscopic surgery is also known as keyhole surgery. Nowadays, a laparoscopic hysterectomy is the preferred treatment method for removing the organs and surrounding tissues of the reproductive system.
During the procedure, a small tube containing a telescope (laparoscope) and a tiny video camera will be inserted through a small incision in your abdomen.
This allows the surgeon to see your internal organs. Instruments are then inserted through other small incisions in your abdomen or vagina to remove your womb, cervix and any other parts of your reproductive system.
Laparoscopic hysterectomies are usually carried out under general anaesthetic.
Vaginal hysterectomy illustration key
1. removing uterus through vagina
2. pelvic bone
4. fallopian tubes and ovaries
If you need to have a hysterectomy, it's important to be as fit and healthy as possible.
Good health before your operation will reduce your risk of developing complications and speed up your recovery.
As soon as you know you're going to have a hysterectomy, take the following steps:
You may need to have a pre-assessment appointment a few days before your operation. This may involve having some blood tests and a general health check to ensure you're fit for surgery. It's also a good opportunity to discuss any concerns and to ask questions.
Read more about preparing for surgery.
Page last reviewed: 22/03/2016
Next review due: 22/11/2018