Hysterectomy, the surgical removal of the uterus, is the second most common surgery for women in the United States (after cesarean section), with approximately 500,000 hysterectomies performed yearly. Traditionally, this surgery was highly invasive because it required a large abdominal incision. Today, by contrast, new research developments and technologies allow surgeons to perform hysterectomies using minimally invasive techniques, which entail smaller incisions, less pain, and quicker recovery.

Yale Medicine surgeons are skilled at these newer, less invasive procedures.

"After a person has considered all of the other options and decides to have a hysterectomy, they should be offered all of the advancements that health care has to offer,” says Linda Fan, MD, director of Yale Medicine Gynecologic Specialties. “In the past, people spent days in the hospital with catheters in place. Surgical technique and technology, as well as post-operative and anesthesia care, have improved so much that many patients feel well enough to leave the same day after surgery and return to their normal lives within a few weeks of major surgery—this would have been inconceivable in decades past." 

Hysterectomy is the surgical removal of the uterus. It is used to treat a range of conditions. One of the most common reasons for hysterectomy is the definitive treatment of uterine fibroid tumors, which are noncancerous growths of the uterus that may cause heavy bleeding, pain, or other bothersome symptoms.

Hysterectomy may also be recommended for other conditions such as cancer, uterine prolapse (when the uterus falls into the vagina), endometriosis (when cells inside the uterine lining grow outside the uterus and cause pain), uterine or cervical cancer, and other causes of chronic pelvic pain or bleeding.

After a hysterectomy, a woman will no longer menstruate or be able to have children. Depending on the severity of the condition, it might be possible to delay surgery until after a woman has had all the children she plans to have.     

There are three main categories of hysterectomy distinguished by what is removed:

• Total hysterectomy: The removal of the entire uterus, including the cervix.
• Supracervical hysterectomy: The removal of the body of the uterus, while the cervix is left intact.
• Radical hysterectomy: The removal of the entire uterus and some of the nearby, surrounding tissues. This surgery is primarily for cancerous conditions, including endometrial and cervical cancers.

Some conditions may require that one or both of the ovaries and/or fallopian tubes be removed in addition to the uterus.

Yale Medicine physicians emphasize safe, minimally invasive surgical techniques. Some of these include:

• Vaginal hysterectomy: In this procedure, a surgeon removes the uterus through the vagina. Studies show that vaginal hysterectomy is safer than traditional surgical methods and requires less hospital recovery time. The physicians at Yale Medicine Urogynecology & Reconstructive Pelvic Surgery are experts in this method, with a track record of success even in complicated cases in which the uterus is larger than normal.
• Laparoscopic hysterectomy: In this procedure, a surgeon makes three or four small abdominal incisions, then inserts a laparoscope—a tiny camera on the end of a tube—into one of them—and other surgical instruments into the other incisions. The camera feeds video to a monitor, which the surgeon uses to guide the surgery. The uterus is removed through the vagina or through the abdominal incisions. This approach also offers quicker recovery, less pain, and shorter hospitalizations compared to traditional abdominal surgery. The physicians in Yale Medicine Gynecologic Specialties are well equipped to perform these advanced surgeries.
• Robot-assisted hysterectomy. In this minimally invasive procedure, a surgeon uses a console to control the movement of robotic arms and surgical instruments. The robotic arms and tools make very precise cuts and movements. A camera and screen allow the surgeon to see a three-dimensional view of the surgery. As in a laparoscopic hysterectomy, the uterus is removed through a few small abdominal incisions. Recovery time and post-surgery pain are usually reduced when compared to other hysterectomy procedures.

In some cases, a physician may opt for an abdominal hysterectomy, a procedure which requires a larger surgical incision than vaginal or laparoscopic hysterectomies.

While hysterectomy is a relatively safe procedure, all surgeries carry certain risks. The most common risks include blood loss, postoperative pain, infection, and possible injury to nearby structures such as the intestines, bladder, blood vessels, nerves, and ureters.

There are also risks of blood clots and complications due to the anesthesia medications. After surgery, it is not unusual to experience pain, constipation, and occasional problems emptying the bladder. In addition, it is common to have spotting or vaginal discharge after surgery.

Many women also have emotional responses to surgery because they can no longer bear children. It is also common for women to feel relief. Women who feel depressed or uneasy in the weeks after a hysterectomy should speak to their doctors about counseling services.

“Women also often worry about a hysterectomy affecting their sexual function, but studies have shown that not to be the case”, according to Dr. Fan

“At Yale Medicine, surgeons are trained in the latest advanced minimally invasive surgical procedures and, as a referral center, they do enough of the surgical cases to ensure expertise. We are able to individualize our plan to the patient’s desires and needs,” says Dr. Fan. “Women undergoing surgery to remove the uterus or other reproductive organs often fear a long, painful recovery. Our gynecologic surgeons, nurses, and anesthesiologists collaborate as a team to provide amazing care that puts the patient at the center. Our goal is to focus on one patient at a time. A caring team with unparalleled expertise coupled with advancements in post-operative care to minimize pain and nausea make this a top-notch experience for patients.”