Hysterectomy procedures vary widely in scarring

special to the Herald-LeaderMay 26, 2013 

Bryan Rone, UKHealth

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A hysterectomy is a surgical procedure that removes the uterus. It's the most commonly performed gynecologic procedure, with approximately 500,000 of these surgeries performed in the U.S. each year.

A hysterectomy is often a recommended form of treatment for women who have uterine fibroids, abnormal menstrual bleeding, pelvic pain, pelvic organ prolapse, or precancerous or cancerous gynecologic conditions. Those facing the procedure often have similar questions:

Will having a hysterectomy leave a scar?

The amount of scarring caused by the surgery depends on the method used during the procedure. There are three ways a gynecologic surgeon can perform a hysterectomy.

Vaginal: The uterus is removed completely through the vagina. The incisions for surgery are internal and hidden at the top of the vagina, meaning that there will be no visible scar on the body.

Laparoscopic: The uterus is removed by placing three or four incisions (less than one centimeter each) in the abdominal wall. This method minimizes visible scarring. Laparoscopic ports are placed through these incisions into the abdominal cavity where a camera and laparoscopic instruments are used to perform the surgery. Robotic hysterectomy is a type of laparoscopic hysterectomy.

Abdominal: The uterus is removed through a larger incision (6-10 inches) either across the lower part of the abdomen or from the navel to the lower part of the abdomen. This method results in the most visible scarring.

What is the recovery like after a hysterectomy?

A hysterectomy is a major surgery. Patients who have a vaginal or laparoscopic hysterectomy will likely stay in the hospital overnight after the surgery and go home the following day. Patients who have an abdominal hysterectomy will usually stay in the hospital 2-3 days.

Post-surgery pain and overall recovery time is reduced with a vaginal or laparoscopic route compared with an abdominal approach. The total recovery time is 4-6 weeks depending on the type of hysterectomy performed.

Which type of hysterectomy will I have?

Your gynecologic surgeon will evaluate many factors before offering you a specific type of hysterectomy. Uterine size, your number of previous abdominal surgeries, and the surgeon's experience are the biggest factors taken into account.

The American College of Obstetrics and Gynecology (ACOG) recommends that vaginal hysterectomy be the first choice, with laparoscopic hysterectomy being a comparable alternative. Abdominal hysterectomy should be the last option.

What if my gynecologic surgeon only offers me an abdominal hysterectomy?

Unfortunately, 50 percent of all hysterectomies performed in the U.S. are still being performed abdominally. If your surgeon recommends an abdominal hysterectomy, ask why. Your surgeon may have a very good reason for offering you an abdominal hysterectomy and should be able to explain this reason to you.

If you still want to see if you're a candidate for a vaginal or laparoscopic hysterectomy, I recommend seeking a second opinion with a gynecologic surgeon who is highly experienced with minimally invasive vaginal and laparoscopic techniques.

Dr. Bryan Rone is a gynecologic surgeon for UK HealthCare.

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