A hysterectomy is a surgical procedure in which a woman’s uterus (womb) is removed. Depending on the specific type of hysterectomy, other reproductive organs, such as the fallopian tubes and ovaries, may be removed or preserved. Hysterectomies are commonly performed for various medical reasons, and the indications for the procedure can vary.

It’s important to note that a hysterectomy is a major surgical procedure with permanent consequences, including losing fertility. Therefore, it is typically considered after other treatment options have been explored and when the benefits of the surgery outweigh the risks and potential side effects. The specific indications and decision to proceed with a hysterectomy should be discussed between the patient, their surgeon, and their healthcare provider, considering individual medical history, symptoms, and preferences.

Common surgical technique for hysterectomy

Vaginal Hysterectomy:

A vaginal hysterectomy or scarless hysterectomy involves the removal of the uterus through the vaginal canal without any incision or scar on your body.

A good candidate for a vaginal hysterectomy:

1. Standard or slightly enlarged Uterine Size

It is recommended to assess the uterine size by ultrasound before a vaginal hysterectomy to ensure that the uterus can be easily removed through the vaginal canal. Large uterine sizes may require an abdominal approach or laparoscopically-assisted vaginal hysterectomy (LAVH), which combines laparoscopic surgery with a vaginal approach.

2. Benign diseases of the uterus

A vaginal hysterectomy is typically performed for non-cancerous conditions such as uterine fibroids, adenomyosis, uterine prolapse, or chronic pelvic pain.

3. Gender Dysphoria

A Hysterectomy for FTM is a gender-affirming procedure for trans men and non-binary individuals that removes the uterus and may also include the removal of the ovaries and Fallopian Tubes (bilateral salpingo-oophorectomy or BSO). A vaginal hysterectomy

4. Patient Preference

Transvaginal hysterectomy or Scarless hysterectomy should be considered a priority for hysterectomy in the selected cases of benign diseases of the uterus who want to avoid scars in their body. It needs some surgical skills but gives less morbidity, less pain, less cost, and good cosmetic results.

Laparoscopic hysterectomy

A laparoscopic hysterectomy, or minimally invasive surgery, is performed entirely through small abdominal incisions using a laparoscope and specialized instruments.

It is associated with shorter hospital stays, less pain, and a quicker recovery than abdominal hysterectomy.

A good candidate for a laparoscopic hysterectomy:

1. Standard or moderately enlarged Uterine Size

Laparoscopic hysterectomy can suit various uterine sizes, including moderately enlarged uteri. However, extremely large uteri may require an abdominal approach.

2. Desire for Minimally Invasive Surgery (MIS)

Patients who prefer a minimally invasive approach should be good candidates for a laparoscopic hysterectomy. The small incisions used in MIS result in more minor scars, which are generally less noticeable. The patients can expect less pain and a quicker recovery time compared to open surgery.

3. Preservation of Ovaries

If ovarian preservation is desired, laparoscopic hysterectomy allows for more precise control in sparing the ovaries.

4. Non-Cancerous Conditions

Laparoscopic hysterectomy is commonly performed for non-cancerous conditions such as uterine fibroids, adenomyosis, endometriosis, and uterine prolapse.

Abdominal Hysterectomy:

In an abdominal hysterectomy, the uterus is removed through an incision in the abdominal wall. The incision is placed horizontally at the bikini line.

It gives the surgeon a good view of the pelvic organs and is suitable for larger uterine sizes or when there are adhesions or scarring from previous surgeries.

Recovery time may be longer than minimally invasive techniques like Vaginal Hysterectomy or Laparoscopic Hysterectomy.