Last updated: July 7, 2021
Hysterectomy Types and Techniques
Having a hysterectomy involves several important decisions for the patient and doctor, most notably concerning the type of hysterectomy — meaning which organs are involved — and the surgical technique, or approach, used to perform it.
A surgeon considers several factors when recommending both the type of hysterectomy and the method used to access the organs. These factors include any underlying diseases, health conditions, the size of the uterus and the patient’s age and preferences.
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CIGC’s fellowship-trained experts have performed thousands of hysterectomies and can help determine what type of procedure is right for you.
Partial Hysterectomy without removal of the ovaries
Partial hysterectomy means that only the uterus, tubes, and cervix are removed. The ovaries are not removed, so menopause will not occur. Any hysterectomy type performed should always remove the fallopian tubes, since this will significantly decrease the risk of tubal cancer.1
In a supracervical hysterectomy, the cervix is kept intact. The uterus is removed above (“supra”) the cervix. The fallopian tubes are removed and the ovaries can either be removed or retained.
Complete Hysterectomy with Removal of the Ovaries
Complete hysterectomy means that the uterus, fallopian tubes, and cervix are removed along with the ovaries. It is important to understand that the ovaries make the important female hormone estrogen, not the uterus. Since the ovaries are removed, estrogen will no longer be made, and menopause will result. For patients in menopause, estrogen therapy is a very safe and effective option to control menopausal symptoms and can be started immediately after the procedure.
Hysterectomy procedures can be performed through three different approaches: laparoscopic (minimally invasive), vaginal (through the vagina), or open (through a large incision).
Laparoscopic hysterectomy is performed through a standard approach, robotics, or DualportGYN. CIGC surgeons exclusively perform DualportGYN procedures, and do not perform robotic or open surgery for hysterectomy. DualPortGYN® is an advanced surgical approach that allows the patient to go home the same day. It requires less time under anesthesia and just two small incisions. Patients experience less pain, smaller incisions, fewer complications and a shorter recovery time compared to robotic or standard laparoscopic methods.
DualPortGYN Compared to Other Hysterectomy Methods
Results published in Gynecological Surgery
Comparative results for Open Hysterectomy estimated from literature review of comparable studies.
DualPortGYN Hysterectomy: The CIGC Choice for Laparoscopic Hysterectomy
The DualPortGYN hysterectomy is also known as laparoscopic retroperitoneal hysterectomy (LRH). It is a minimally invasive procedure that uses just two 1/4-inch incisions — one through the belly button and the other at the bikini line. The two key elements to this technique are called retroperitoneal dissection (RPD) and uterine artery ligation (UAL).
Retroperitoneal dissection involves entering the peritoneum, which is a filmy “blanket” covering the reproductive organs. This route lets the surgeon map the anatomy of the pelvis so that nearby vital structures — including the bladder, ureters, bowel and nerves — are clearly identified to reduce the risk of injury. Retroperitoneal dissection is a technically difficult procedure and should be performed by specially trained, high-volume surgical experts.
GYN Oncologists or GYN Oncology trained surgeons master Retroperitoneal Dissection as part of their training. CIGC surgeons are GYN Oncology trained and have been trained exclusively in the RPD approach and use it for all hysterectomy procedures performed. OBGYN’s and Laparoscopic Fellowship trained surgeons in general are not GYN Oncology trained, have minimal exposure to the RPD approach, and do not use it routinely for surgery.
Uterine artery ligation, or clamping the uterine artery, is one of the most important aspects of DualportGYN hysterectomy. By ligating the uterine artery in the retroperitoneal space, blood loss is far better controlled than ligation of the artery at the side of the uterus as with robotic and standard laparoscopic hysterectomy. This dramatically decreases complications and operative times and allows for removal of very large fibroid uteri.
Other Surgical Approaches
CIGC surgeons do not use Robotic, Standard Laparoscopic, Vaginal, or Open surgery to perform hysterectomy. Please refer to published studies by CIGC comparing hysterectomy approaches for further information and verification in this website.
For completeness, a short summary of these procedures is included.
In a robotic-assisted laparoscopic surgery, the surgeon sits at a console several feet away from the patient and electronically manipulates a multi-armed surgical instrument unit placed over the surgical area, while a camera provides 3D, magnified viewing. An assistant is at the patient’s side.
Standard minimally invasive hysterectomy uses between three and four ¼-inch to ½-inch incisions. This method is used by laparoscopic specialists and many OBGYN surgeons alike. As with all surgical methods for hysterectomy, standard laparoscopy depends on the training and skill of the surgeon doing the procedure. Most OBGYNs do not have the same skills or perform as many laparoscopic hysterectomies as GYN surgical specialists.
Vaginal hysterectomy (also called total vaginal hysterectomy) is the removal of the uterus, with or without the ovaries, completely through the vaginal opening. This procedure does not require any incisions in the abdomen. This approach is limited to normal size or smaller uteri, often in patients who have had a vaginal delivery to allow for greater access for the surgery.
Open hysterectomy, also called abdominal hysterectomy, is still the most common method used for hysterectomy in the United States. This procedure uses a large incision, either horizontal or vertical, to open the abdomen and remove the uterus.
The reason most patients undergo an open hysterectomy is the limited laparoscopic training of their OBGYN. There are rare cases in which open surgery is necessary — discuss the alternatives to open surgery with your surgeon so that you are ensured of the best possible approach to your procedure.
Consult an Expert for More Information
CIGC’s hysterectomy specialists can help you learn more about the significant advantages of the DualportGYN approach to hysterectomy. Contact our team to schedule an evaluation.
1ACOG Committee Opinion No. 774 Summary: Opportunistic salpingectomy as a strategy for epithelial ovarian cancer prevention. Obstet Gynecol. 2019;133(4):842-843. doi:10.1097/AOG.0000000000003165
2Danilyants, N, MacKoul, P, van der Does, L et al. A value-based evaluation of minimally invasive hysterectomy approaches. Gynecol Surg. 2019:16(5)
3Committee Opinion No 701: Choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2017:129(6):e155-e159. doi: 10.1097/AOG.0000000000002112
4Lee S, Oh S, Cho Y et al. Comparison of vaginal hysterectomy and laparoscopic hysterectomy: a systematic review and meta-analysis. BMC Womens Health. 2019;19(1):83.