A hysterectomy is the surgical removal of the uterus. Depending on the type of hysterectomy, other pelvic organs or tissues also may be removed. The types of hysterectomy include:
Subtotal, supracervical or partial hysterectomy. The uterus is removed, but not the cervix.
Total or complete hysterectomy. Both the uterus and the cervix are removed.
Total hysterectomy plus unilateral salpingo-oophorectomy. This procedure removes the uterus, cervix, one ovary and one fallopian tube, while one ovary and one fallopian tube are left in place. This procedure is usually done if a problem confined to one ovary is detected at the time of hysterectomy. After surgery, the remaining ovary should produce enough female hormones if the woman has not reached menopause.
Total hysterectomy plus bilateral salpingo-oophorectomy. This is the removal of the uterus, cervix, and both fallopian tubes and ovaries. Removing both ovaries will cause surgical menopause in a woman who has not reached menopause because the production of female hormone stops when the ovaries are removed.
Radical hysterectomy. This procedure removes the uterus, cervix, both ovaries, both fallopian tubes and nearby lymph nodes in the pelvis. This procedure is only done in some women who have gynecological cancer.
Hysterectomies can be done with different types of surgical incisions (surgical cuts). Until recently most hysterectomies were abdominal hysterectomies, in which the uterus is removed through a horizontal or vertical incision in the lower abdomen.
Now about 50% of hysterectomies are done using a laparoscope, a telescope-like instrument with a camera for viewing inside the abdomen. The surgeon makes several small incisions in the abdomen that allow the insertion of instruments to help remove the uterine attachments. Once freed from its attachments, the uterus can be removed either through the vagina (laparoscopic assisted vaginal hysterectomy) or in pieces through the small abdominal incisions (total laparoscopic hysterectomy). As laparoscopic techniques continue to improve, the number of hysterectomies done by this approach will increase.
Vaginal hysterectomies, in which the uterus is removed through an incision in the vagina, are done about 20% of the time. When considered equally safe, most experts prefer the vaginal approach rather than a traditional abdominal hysterectomy because the recovery time is much faster.
Hysterectomy is a very common surgical procedure in the United States, especially in middle-aged women between 40 and 50. About one out of every three women in the United States eventually has a hysterectomy.