Hysterectomy: Types, Indications, Recovery, and Risks

Hysterectomy = surgical removal of the uterus. Indications: abnormal uterine bleeding, fibroids, endometriosis, prolapse, gynecologic cancer, chronic pelvic pain (refractory).

Surgical Approaches

• Vaginal: No abdominal incisions; fastest recovery; for benign, mobile uterus.
• Laparoscopic (TLH/LAVH): 3–4 small incisions; camera-assisted; less pain, shorter stay.
• Robotic-assisted: Enhanced dexterity; similar to laparoscopic.
• Abdominal: Large incision; for large uterus, cancer, extensive adhesions.

Ovarian Conservation

Ovaries may be preserved (premenopausal) to avoid surgical menopause. If removed (BSO), immediate menopause occurs; hormone therapy often recommended.

Recovery Timeline

• Vaginal/laparoscopic: 2–4 weeks.
• Abdominal: 6–8 weeks.
• Restrictions: No heavy lifting (>10 lbs), vaginal insertion, driving while on narcotics.

Risks

• Bleeding, infection, ureter/bladder/bowel injury (rare).
• Vaginal cuff dehiscence.
• Lymphedema (if nodes removed).
• Psychological impact (loss of fertility, identity).

Shared decision-making with gynecologist ensures appropriate route and counseling.