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.

Total hysterectomy

Duringa total hysterectomy, yourwomb 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 youdeveloping Cervical cancer at a later date.

Subtotal hysterectomy

A subtotal hysterectomy involves removing the main body of the womb andleaving 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.

Radical hysterectomy

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'tworked.

During the procedure, the body ofyour womb and cervixis removed, along with:

• your fallopian tubes
• part ofyour vagina
• ovaries
• lymph glands
• fatty tissue

Performing ahysterectomy

There are three ways ahysterectomy can be performed. These are:

• vaginal hysterectomy
• abdominal hysterectomy
• laparoscopic hysterectomy

Vaginal hysterectomy

During a vaginal hysterectomy, the womb and cervix are removed through an incisionthat's made in the top of the vagina.

Special surgical instruments are inserted into the vagina todetach the womb from the ligaments that hold it in place.

After the womb and cervix have been removed, the incision will besewn up. The operation usually takesabout anhour 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 benumb from the waist down

A vaginal hysterectomy is usually preferred over an abdominal hysterectomy, because it's less invasive and involvesa shorter stay in hospital. The recovery time also tends to be quicker.

Abdominal hysterectomy

During an abdominal hysterectomy, an incision will be made in your abdomen (tummy).It willeither be made horizontally along your bikini line,or vertically from your belly button to your bikini line.

A vertical incisionwill usually beused if there are large fibroids (non-cancerous growths) in yourwomb, or for some types of cancer.

After yourwombhas beenremoved, the incisionisstitched up. The operation takes about an hourto perform anda general anaestheticis used.

An abdominal hysterectomy may be recommended if your womb is enlarged by fibroids or pelvic tumours and it'snot possible to remove it through your vagina.

It may also be recommended if your ovaries need to be removed.

Laparoscopic hysterectomy

Laparoscopic surgery is also known as keyhole surgery. Nowadays, a laparoscopic hysterectomy isthe preferred treatment method for removing theorgans and surrounding tissues of the reproductive system.

During the procedure, asmall tube containinga telescope (laparoscope) and a tiny video camera will beinserted through a smallincision inyour abdomen.

This allowsthe surgeon to see yourinternal organs. Instrumentsare theninserted through other smallincisions in yourabdomen or vagina to removeyour womb, cervix and any other parts of your reproductive system.

Laparoscopic hysterectomies are usually carried outunder general anaesthetic.