A New Type of Hysterectomy

Medical Author: Melissa Stoppler, M.D.
Medical Editor: Barbara K. Hecht, Ph.D.

There is a relatively new type of hysterectomy that is called laparoscopic supracervical hysterectomy or SCH, for short. SCH can greatly reduce hospital stay, postoperative pain, and recovery time when compared with older "traditional" surgical hysterectomy procedures.

Hysterectomy, or surgical removal of the uterus, is a common surgical procedure. It is done over 600,000 times a year in the US. Sometimes the ovaries and fallopian tubes are also partially or entirely removed during a hysterectomy.  

The most frequent reason for hysterectomy is the presence of benign fibroid tumors (leiomyomata) in the uterus, but hysterectomies are also performed to treat abnormal uterine bleeding, uterine prolapse (loosening of the supporting tissues in the pelvis), endometriosis, and cancer of the uterus.

The most common type of surgical procedure for hysterectomy is known as a total abdominal hysterectomy (TAH). In TAH the incision (cut) is made in the abdominal wall in order to gain access to the uterus. The uterus may alternatively be removed through an incision made within the vagina (vaginal hysterectomy) if the uterus is not overly large or when examination of the adjacent organs is not necessary. Both TAH and vaginal hysterectomy require several days of hospitalization and weeks of recovery time.

SCH was developed in the 1990s. It is considered a "minimally invasive" procedure. During SCH a  laparoscope is inserted through an umbilical incision to transmit images. The surgeon inserts additional instruments through tiny abdominal incisions and removes the uterus. The ovaries may or may not be removed in SCH, but the cervix (the lower part of the uterus just above the vagina) is left intact. (Laparoscopic guidance has also been used in vaginal hysterectomy, but this remains an invasive surgical procedure with a vaginal incision.)

With SCG the hospital stay is significantly reduced and may be limited to a few hours or overnight. Recovery times and postoperative pain are also dramatically reduced. The retention of the cervix also helps to stabilize the pelvic structures, leading to better preservation of sexual functioning.

Some women who need hysterectomies are not candidates for this new procedure. Those who have a very large uterus due to fibroids or women with cancer are among those who should have a traditional hysterectomy.

The American College of Obstetrics and Gynecology (ACOG) recommends that hysterectomy should only be performed for medical reasons, and only after alternative options have been discussed and explored with the patient.  ACOG also recommends that, if a physician advises a hysterectomy, women should consider getting opinions from one or more other physicians.