In a vaginal hysterectomy, the uterus is removed through the vagina instead of through the abdomen. This enables a much faster recovery than an abdominal incision. It also results in much smaller scars, or even no visible scars at all. It is technically more difficult. Many abdominal hysterectomies are still performed simply because doctors do not have the skills for the less invasive surgery. The majority of hysterectomies performed in the United States use abdominal incisions, though there are several less invasive options.
There are several types of vaginal hysterectomies. In the simplest, the surgeon removes the uterus through an incision in the vagina. The technical difficulty is greater than in an abdominal surgery because the surgeon has less operating space and cannot see the pelvic organs as he or she works. Patients generally are hospitalized for one to two days and can return to work after one to two weeks. The operation can cause reduced sexual function because the vagina is shortened or tightened by surgery.
Laparoscopic-Assisted Vaginal Hysterectomy
In a laparoscopic-assisted vaginal hysterectomy, several small incisions are made in the abdomen and instruments including a laparoscope are inserted. The doctor views the surgical site through the scope. The uterus is cut into pieces, which can either be removed through the laparoscope, through any of the incisions made to insert it or through the vagina. This surgery is more expensive and takes longer, but patients are able to leave the hospital sooner and recover more quickly.
Da Vinci Hysterectomy
The least invasive hysterectomy available today uses the da Vinci robot and techniques similar to a laparoscopic surgery. The robot provides doctors with a high-definition, 3D, magnified view of the surgical site. The surgeon operates the robot, which makes movements that are tinier and more precise than can be managed by the human hand. There are generally several small incisions, one through the belly button. The uterus is typically removed vaginally. Patients who have da Vinci surgery lose less blood and recover more quickly. Some are able to leave the hospital the same day as their procedure.
Warning
A doctor who experiences complications during any of these surgeries may be forced to resort to an abdominal incision.
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