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A hysterectomy is used to treat several conditions. If you decide to have a hysterectomy, you and your health care professional should discuss which type is most appropriate. There are three types:

• Total hysterectomy: During this procedure, your uterus and cervix are removed. Your ovaries and fallopian tubes may or may not be removed at the same time. If your ovaries are not removed, you will continue to have menstrual cycle-related hormonal changes, but you won't have any bleeding.

  If your ovaries and fallopian tubes are also removed, called a bilateral salpingo-oophorectomy, you won't have those monthly hormonal changes. Removing only the uterus can reduce the blood supply to the ovaries, however, ultimately decreasing their function.

  Whether to leave the ovaries intact is a controversial issue. Some experts point to the risk of ovarian cancer or ovarian cysts if the ovaries remain, which could require further surgery. However, a study published in the December 2000 issue of Obstetrics & Gynecology found that leaving the ovaries may increase a woman's long-term survival. That's because even after menopause, the ovaries make continue to produce small amounts of estrogen, which may help protect against heart disease and can help prevent osteoporosis.

  How close you are to menopause and your current estrogen levels should be considered in any decision to remove the ovaries. Ask your health care professional to explain this information to you so you can better understand your surgical options.

• Radical hysterectomy. This type of hysterectomy is performed for early stage cervical cancer. During this procedure, your uterus, cervix, supporting ligaments and tissues, the upper portion of the vagina and the pelvic lymph nodes are removed. Cancer specialists usually perform this type of hysterectomy.

• Subtotal, partial or supracervical hysterectomy. In this procedure, only the part of your uterus above the cervix is removed. There is a small risk that cancer could develop in the remaining part of the cervix, however. Nonetheless, there are some benefits to leaving the cervix intact, including a reduced risk of vaginal prolapse (the vagina falling out), shorter recovery time and less postoperative pain. Some studies also suggest that leaving the cervix allows intercourse to remain pleasurable.

In addition to discussing which organs should be removed during a hysterectomy, you and your health care professional should also discuss how the surgery will be performed. The surgical technique you choose should depend on your individual diagnosis, personal preference and your surgeon's training. They include:

• Total abdominal, or open, hysterectomy. This is the classic form of hysterectomy, involving an abdominal incision. This allows the surgeon to easily view the pelvic organs and provides more operating space than a vaginal hysterectomy allows. It is generally used for large pelvic fibroids or cancer.

  If you have this form of hysterectomy, expect a longer hospital stay and recuperation time. In most cases, your surgeon can make a "bikini line" incision that your bathing suit hides. Exceptions include cancer surgery or surgery to remove extremely large fibroids. Complete recovery from abdominal hysterectomy can take between two and eight weeks, during which time you'll gradually feel your strength return and gradually be able to resume your normal activities.

• Vaginal hysterectomy. In this procedure, the surgeon removes the uterus and the cervix through an incision within the vagina, so there's no large external scar. This form of hysterectomy is ideal when there is uterine prolapse and minimal uterine enlargement.

  Vaginal hysterectomy can be performed in two ways: entirely through the vagina or using a laparoscope, a small, telescope-like device inserted into the abdomen through a small incision, enabling the surgeon to visualize the pelvic region, also called a laparoscopic assisted hysterectomy.

  Standard vaginal hysterectomy and abdominal hysterectomy each take between one and two hours and are performed under regional (epidural or spinal) or general anesthesia. One study found that women who had a vaginal hysterectomy had significantly fewer complications than those having abdominal hysterectomy. Additionally, the study found the women had shorter hospital stays and returned to their normal activities more quickly than the women who had the abdominal hysterectomies.

  Women with large ovarian cysts, a serious case of endometriosis or large fibroids may not be candidates for vaginal hysterectomy.

• Laparoscopically assisted vaginal hysterectomy (LAVH). This approach is used if the ovaries are also going to be removed during a vaginal hysterectomy. The laparoscope may also be used to remove the uterus through the vagina. This procedure requires more advanced surgical skill to perform. During a LAVH, the uterus along with ovaries are detached from their supporting structures and blood supply, then are removed through an incision in the vagina.

• Laparoscopic supracervical hysterectomy (LSH). This newer type of hysterectomy also uses laparoscopic techniques to remove the uterus, but leaves the cervix intact, which some studies suggest may help reduce the complications associated with total hysterectomies, such as genital prolapse and urinary incontinence.

• Computer-assisted surgery. In April 2005, the FDA approved the da Vinci surgical computer operating system for gynecological laparoscopic procedures. The da Vinci system enables the surgeon to perform surgery through smaller incisions. The system involves up to four robotic "arms" that are inserted into the woman through small incisions. One arm holds a miniature camera, and the other arms hold a variety of instruments. The surgeon directs the procedure from a console several feet away, which provides a magnified three-dimensional view of the surgical field.

Outpatient surgery and overnight observation stays are common for all types of hysterectomies. Hospitalization, when needed, almost never exceeds 72 hours. Although normal activities may be resumed gradually, a woman may not be fully recovered until four to six weeks or longer following surgery, depending on the surgical approach used.

However, no data currently exists that supports the use of the da Vinci surgical computer over currently used surgical technology for these procedures.

Possible Complications

While discussing hysterectomy techniques with your health care provider, you should also talk about possible complications. According to the National Center for Health Statistics, 25 to 50 percent of women who undergo a hysterectomy experience one or more complications from surgery, most of which are minor or reversible. Possible complications include:

• Fever and infection following surgery

• Urinary tract infection or discomfort

• Menopausal symptoms, such as hot flashes, night sweats and vaginal dryness, if your ovaries are removed

• Constipation

• Fatigue

• Depression or other emotional problems

• Pain or discomfort during intercourse

• Loss of sexual pleasure or interest in sex

More serious, but rarer, complications may include:

• Hemorrhage requiring transfusion

• Injury to the bowel, bladder or other internal organs during surgery, requiring repair

• Life-threatening cardiopulmonary events such as a heart attack

• Urinary tract infections or discomfort

If your ovaries are removed, you may experience a sudden drop in hormone levels, which may produce menopausal symptoms such as hot flashes, night sweats and dizziness. Postmenopausal hormone therapy (HT), taken soon after surgery, may offset menopausal symptoms. Although the safety of postmenopausal hormone therapy is now under intense scrutiny by the federal government, there is little argument that premenopausal women thrust into sudden menopause by removal of the ovaries will require supplemental estrogen.