There are several different hysterectomy procedures, each with advantages and disadvantages. Depending on your reason for considering a hysterectomy, you may have a choice between two or more procedures. For complicated or cancer-related conditions that require maximum access and careful examination, your doctor will likely recommend only an abdominal hysterectomy.

Vaginal hysterectomy

This type of hysterectomy is performed through a small incision in the vagina, rather than through an abdominal incision. The ovaries and other organs may also be removed. Vaginal hysterectomy tends to cause less pain, and takes less healing time than abdominal hysterectomy. A vaginal hysterectomy can be done:

• To remove small uterine fibroids.
• When the uterus is of normal size or slightly enlarged. However, some experienced surgeons are able to safely remove a very enlarged uterus without higher risk of complications.⁶
• When endometriosis growths (implants) are not present.

Vaginal hysterectomy requires more specialized surgical skill than an abdominal hysterectomy. It can pose a higher risk of injury to other organs. Vaginal hysterectomy is not used when there is a question about possible cancer in the uterus, cervix, or ovaries.

Abdominal hysterectomy

This type of hysterectomy is done through a larger abdominal incision, giving the surgeon the best possible access to the pelvic organs. The cervix may be removed with the uterus (total hysterectomy) or left in place (subtotal hysterectomy). The ovaries and other organs may also be removed. An abdominal hysterectomy is typically done when:

• The uterus is very large.
• Uterine fibroids are larger than 8 in. across or located around blood vessels.
• Cancer of the uterus, ovaries, or cervix is possible.
• An ovarian growth (mass) is suspected but can't be diagnosed on ultrasound.
• There is significant scarring or severe endometriosis in the pelvic area.

If a hysterectomy is chosen to treat endometriosis, an abdominal hysterectomy is usually required; for example, when endometriosis growths (implants) or scar tissue (adhesions) must be removed to restore the function of other organs.

Laparoscopically assisted vaginal hysterectomy (LAVH)

Laparoscopic hysterectomy is done with a viewing instrument (laparoscope) and surgical instruments inserted through a vaginal incision and one or more small abdominal incisions. The ovaries and other organs may also be removed. The uterus is detached from scar tissue, then removed through the vagina. It is done:

• When uterine fibroids are small to moderate in size.
• When the uterus is slightly larger than normal.
• To remove endometriosis and scar tissue (adhesions) confined to the uterus, fallopian tubes, and ovaries.
• To assess or remove ovaries at the same time as a vaginal hysterectomy.

LAVH is a newer surgery and requires the surgeon to have specialized training.

Laparoscopic supracervical hysterectomy (LSH)

Laparoscopic supracervical hysterectomy is done by inserting a laparoscope and surgical instruments through several small abdominal incisions. The uterus is removed in small pieces through a surgical instrument; the cervix is left intact (this is also known as subtotal or partial hysterectomy). This type of procedure usually causes minimal blood loss and pain. The hospital stay is shorter than for total abdominal surgery. Most women can return to normal activity a week or two afterward. LSH can be done:

• To remove uterine fibroids of any size.
• To remove a uterus of any size.