Hysterectomy procedures

Abdominal hysterectomy is done when:

• The uterus is large.
• Uterine fibroids are larger than 8 in. (20.3 cm) across.
• An ovarian mass is suspected.

An abdominal hysterectomy is usually required to remove endometriosis implants and adhesions to restore the function of other organs involved.

Vaginal hysterectomy can be done:

• To remove uterine fibroids that are small.
• When the uterus is of normal or slightly enlarged size.
• When endometriosis implants are not present.

This surgery requires more specialized surgical skill than an abdominal hysterectomy.

Laparoscopically assisted vaginal hysterectomy (LAVH) can be done:

• When uterine fibroids are small to moderate in size.
• When the uterus is slightly larger than normal.
• When a woman has never given birth (nulliparous).
• To remove endometriosis and adhesions confined to the uterus, fallopian tubes, and ovaries.

LAVH is a newer surgery and requires specialized surgical training.

Laparoscopic supracervical hysterectomy (LSH) can be done:

• To remove uterine fibroids of any size.
• To remove a uterus of any size.

LSH is performed by inserting a laparoscope (lighted viewing instrument) and surgical instruments through several small abdominal incisions. The uterus is removed in small pieces with a special surgical instrument. This type of surgery usually causes minimal blood loss and pain, and women reportedly can return to work a week or two afterward.

Since LSH leaves the cervix intact, women continue with their regular Pap smears, which check for cervical precancer and cancer. LSH is a newer surgery and requires specialized surgical training. It is not yet widely available.