Hysterectomy Procedure

By Hitt, Emma

(Removal of the Uterus)

Procedure overview

What is a hysterectomy?

Hysterectomy is the surgical removal of the uterus. Different portions of the uterus, as well as other organs, may be removed at the same time.

The types of hysterectomy include:

  • Total hysterectomy. Includes the removal of the entire uterus, including the fundus (the part of the uterus above the openings of the fallopian tubes) and the cervix, but not the tubes or ovaries. This is the most common type of hysterectomy.

  • Hysterectomy with salpingo-oophorectomy. Includes the removal of one or both ovaries, and the fallopian tubes, along with the uterus.

  • Radical hysterectomy. Includes the removal of the uterus, cervix, the top portion of the vagina, most of the tissue that surrounds the cervix in the pelvic cavity, and may include the removal of the pelvic lymph nodes. This is done in some cases of cancer.

  • Supracervical hysterectomy (partial or subtotal hysterectomy). Removal of the body of the uterus while leaving the cervix intact

In addition to the different types of hysterectomies, there are different surgical techniques used to perform a hysterectomy. Surgical hysterectomy techniques include:

  • Abdominal hysterectomy. The uterus is removed through the abdomen via a surgical incision about six to eight inches long. This procedure is most commonly used when the ovaries and fallopian tubes are being removed, when the uterus is enlarged, or when disease has spread to the pelvic cavity, as in endometriosis or cancer. The main surgical incision can be made either vertically, from the navel down to the pubic bone, or horizontally, along the top of the pubic hairline.

  • Vaginal hysterectomy. The uterus is removed through the vaginal opening. This procedure is most often used in cases of uterine prolapse, or when vaginal repairs are necessary for related conditions. No external incision is made, which means there is no visible scarring.

  • Laparoscope-assisted vaginal hysterectomy. Vaginal hysterectomy is performed with the aid of a laparoscope, a thin, flexible tube containing a video camera. Thin tubes are inserted through tiny incisions in the abdomen near the navel. The uterus is then removed in sections through the laparoscope tube or through the vagina.

The type of hysterectomy performed and the technique used to perform the procedure will be determined by your physician, based upon your particular situation.

For women who have not yet reached menopause, having a hysterectomy means that menstruation will no longer occur, nor will pregnancy be possible.

What are female pelvic organs?

The organs and structures of the female pelvis are:

  • Endometrium. The lining of the uterus

  • Uterus. Also called the womb, the uterus is a hollow, pear-shaped organ located in a woman's lower abdomen, between the bladder and the rectum. The uterus sheds its lining each month during menstruation, unless a fertilized egg (ovum) becomes implanted and pregnancy follows.

  • Ovaries. Two female reproductive organs located in the pelvis in which egg cells (ova) develop and are stored, and where the female sex hormones estrogen and progesterone are produced

  • Cervix. The lower, narrow part of the uterus located between the bladder and the rectum, forming a canal that opens into the vagina, which leads to the outside of the body

  • Vagina. The passageway through which fluid passes out of the body during menstrual periods. Also called the "birth canal," the vagina connects the cervix and the vulva (the external genitalia).

  • Vulva. The external portion of the female genital organs

Reasons for the procedure

Reasons for performing a hysterectomy include, but are not limited to, the following:

  • Fibroid tumors (nonmalignant tumors)

  • Endometriosis (a condition in which endometrial cells grow outside of the uterus, attaching themselves to other organs in the pelvic cavity, resulting in chronic pelvic pain, pain during sex, and prolonged or heavy bleeding)

  • Abnormal uterine bleeding (this is often due to endometrial hyperplasia, an over-thickening of the uterine lining that may cause abnormal bleeding)

  • Cancer (cervical, ovarian, or endometrial cancer is the diagnosis in approximately ten percent of hysterectomies)

  • Blockage of the bladder or intestines by the uterus or a growth