Topic Overview

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.
• When there is no significant scarring in the pelvis from previous surgeries.

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.