Hysterectomies—the surgical removal of the uterus—have been performed since ancient times and remain one of the most common procedures among women and people assigned female at birth (AFAB).
But the reasons for performing them, and how they are done, have changed dramatically. Minimally invasive techniques like laparoscopy and robotic surgery have made hysterectomies safer, more precise and easier to recover from.
“A hysterectomy should never be done for sterilization. There are other better and safer options for sterilization,” says Dr. D’Orsi. “Instead, a patient may need a hysterectomy for various reasons. Some of the most common are abnormal bleeding, pain, fibroids or different types of cancers.”
While hysterectomy is now a common and effective procedure, no surgery is without risk. It’s important to talk with your doctor to fully understand your options and make the best decision for your health.
Types of hysterectomy
There are several types of hysterectomy, depending on how much of the uterus and surrounding structures are removed:
- Total hysterectomy: Removes the entire uterus and cervix.
- Partial (supracervical) hysterectomy: Removes the body of the uterus, leaving the cervix intact.
- Radical hysterectomy: Removes the uterus, cervix, upper part of the vagina, and sometimes nearby lymph nodes, typically for cervical cancer.
“Fallopian tubes are also typically removed,” says Dr. D’Orsi. “Some patients also need to have their ovaries removed at the same time—this is called a bilateral salpingo-oophorectomy.”
Historically, these procedures required a large abdominal incision. This open surgery meant longer recovery times, more pain, greater blood loss and a higher risk of complications. Today, thanks to advances in technology, hysterectomies can be performed with much less disruption to the body.
“Most hysterectomies are now done via a minimally invasive approach; this means via laparoscopic or robotic surgery or vaginal surgery,” says Dr. D’Orsi. “An open surgery via a cut on your abdomen is usually reserved for a large fibroid uterus or different types of cancer.”
How robotic-assisted surgery works
Robotic-assisted surgery may sound high-tech, but it’s really just another tool in the hands of a skilled surgeon. In these procedures, the surgeon operates using a console to control robotic arms with extreme precision. The system also provides a high-definition 3D view of the surgical site.
Both robotic and laparoscopic surgeries use 4 to 5 small incisions, each about the width of a fingernail. The uterus and cervix are removed through the vagina. “So, the biggest incision is the one you can’t see at the top of the vagina,” says Dr. D’Orsi.
Quicker recovery, better outcomes
The benefit of small incisions goes far beyond aesthetics. Less invasive surgery means less pain, less blood loss and fewer complications, which all contribute to a faster, smoother recovery. In fact, many patients go home the same day.
“We follow a protocol called ‘Enhanced Recovery after Surgery,’” says Dr. D’Orsi. “This protocol gives you medications before and after that help you feel better after. It involves pretreating your nausea and pain. The first night after surgery, you will mostly want to sleep. Sometimes patients may need a stronger narcotic medication for 1 or 2 days, but many patients only need to take an NSAID and/or acetaminophen after surgery.”
Patients are typically advised to avoid lifting more than 10 pounds for 4 to 6 weeks, and nothing should be inserted into the vagina for about 8 weeks. However, many return to their normal routines quickly.
And how do people feel long-term after a hysterectomy?
“Everyone reacts differently,” says Dr. D’Orsi. “Some patients feel a great relief because they have been struggling with daily pain or daily bleeding.
Some patients feel a loss like they have lost part of themselves. For patients who have their ovaries removed, depending on their age and risk factors, they may be candidates for hormone replacement therapy.”
The bottom line
Despite the many advances that make hysterectomy safer and more practical, Dr. D’Orsi emphasizes that it’s just one of many treatment options available.
“It’s just one of many treatments,” she says. “There are other medical and surgical options for many of the indications for hysterectomy so it’s important to speak with a doctor who can help you understand all of your options and your desired outcomes.”
