Until recently, the vaginal approach has been considered to be the preferred approach when it is possible. The benefits include no visible scars, a shorter recovery time and fewer complications compared to other approaches (however this may not be true when compared to a laparoscopic approach). To be able to perform a vaginal hysterectomy, the ligaments which hold the top of vagina and cervix must be able to be reached. This may not be possible if you have not had a vaginal birth before. A vaginal approach also may not be recommended if your uterus is large, there are concerns of previous scar tissue, or if you have certain types of gynaecological cancer. You will often spend 2-3 nights in hospital after the procedure and can expect to recover over the next 2-6 weeks.
In most circumstances, this is now considered the optimal approach for performing a hysterectomy. The use of small incisions allows for recovery times similar to or better than a vaginal hysterectomy. A laparoscopic approach allows the surgeon to see other organs around the uterus such as the bladder and bowel as well as any previous scar tissue. A laparoscopic hysterectomy should only be performed by a gynaecologist who has received advanced training in laparoscopic surgery and we recommend you ask what training your doctor has had and how many of these procedures they have performed. A laparoscopic hysterectomy is more complex if you have a very large uterus or a condition such as endometriosis. While it still may be possible to have a laparoscopic hysterectomy in these circumstances, it is even more important that you are confidence with your gynaecologists training and experience. Most women will be ready to go home the day after the operation although some will require a second night in hospital. Recovery can be expected to take two to three weeks.
An abdominal approach has largely been replaced by a total laparoscopic approach although there are several reasons why your doctor may suggest this approach as the most suitable for your circumstances. These include an enlarged uterus that limits the ability of the surgeon to see at laparoscopy, severe scar tissue from previous operations, or concerns of potential underlying cancer. An abdominal approach offers the greatest visibility and flexibility, but it comes at the expense of a large abdominal incision and a slower recovery. You will often spend three to five nights in hospital and require a minimum of six weeks to recover from the procedure.