What are the different types of hysterectomy?

A hysterectomy is a commonly performed and generally safe surgical procedure. Unless there is uterine prolapse, most gynaecologist's remove the womb through the abdominal wall (abdominal hysterectomy). A vaginal hysterectomy indicates that the uterus has been taken out through the vagina. When there is prolapse of the uterus and heavy periods, vaginal hysterectomy and pelvic floor repair (6) may solve two problems.

Figure 24.4 shows the options available at abdominal hysterectomy. A total hysterectomy is when all of the womb, including the neck of the womb (cervix), is removed (24). In subtotal hysterectomy, the body of the uterus is removed but the neck of the womb is left in place. Total abdominal hysterectomy and bilateral salpingo-oophorectomy is the removal of the ovaries and tubes (25).

More complex surgery may be required when the hysterectomy is performed for malignancy. Lymphadenectomy is the removal of the local lymph glands. During a Wertheim's hysterectomy, required for some women with early cancer of the neck of the womb (cervical cancer), connective tissue adjacent to the uterus is removed together with the local lymph glands (lymphadenectomy).

Some gynaecologists have been trained to remove the uterus vaginally with the assistance of laparoscopy (laparoscopically assisted vaginal hysterectomy). As with all minimally invasive procedures (Q4.23), we are only just coming out of the pioneering stages. Usually, three or four small incisions are required to introduce all the instruments that are necessary. It has, however, been shown that if the uterus is not enlarged, an abdominal scar of no more than 10cm is required to perform a conventional hysterectomy and many gynaecologists remain comfortable with this approach. Laparoscopic hysterectomy may require less pain relief after surgery but the operation lasts one hour longer.

Sometimes, complications occur during childbirth or caesarean section and a caesarean hysterectomy is required.

There is evidence that vaginal hysterectomy has advantages over abdominal and laparoscopically assisted vaginal hysterectomy.0609

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This is the personal website of David A Viniker MD FRCOG, retired Consultant Obstetrician and Gynaecologist - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

The aim of this web site is to provide a general guide and it is not intended as a substitute for a consultation with an appropriate specialist in respect of individual care and treatment.

David Viniker retired from active clinical practice in 2012.
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