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Total hysterectomy

A total hysterectomy removes the whole body of the uterus and the cervix.

It does NOT remove the:

• Parametrium, the loose connective tissue around the uterus
• Uterosacral ligaments, the tissue connecting the uterus and sacrum
• Vagina

A bilateral salpingo-oophorectomy (BSO) is a separate procedure that removes the ovaries and fallopian tubes. It can be done along with a hysterectomy in the same operation when needed.

There are a few types of hysterectomy procedures:

• Abdominal hysterectomy, uterus is removed through a 6- to 8-inch cut (incision) in the abdomen
• Laparoscopic abdominal hysterectomy, uterus is removed through 3 to 5 small cuts in the belly using a laparoscope, a thin, lighted tube with a camera on the end where small tools can be inserted and used
• Robotic-assisted hysterectomy, uterus is removed through the vagina or small cuts in the abdomen with a laparoscope. With a robotic approach, the surgeon sits at a control panel in the operating room, using robot arms to operate
• Vaginal hysterectomy, uterus is removed through the vagina
• Laparoscopic vaginal hysterectomy, uterus is removed through the vagina with the assistance of a laparoscope

Laparoscopic procedures have shorter recovery times than abdominal hysterectomies, but are not possible for all people. Talk with your surgeon about how the surgery will be done and why it's the best plan for you.

For this procedure, you might be under either:

• General anesthesia, in a deep sleep
• Regional anesthesia, sedated and numb from the waist down

Possible side effects

After a hysterectomy, a person cannot become pregnant and won’t have a menstrual period. Surgical complications are rare but could include:

• Bleeding
• Infection
• Damage to the urinary (bladder and ureters) or bowel systems

For an abdominal hysterectomy, the hospital stay is usually 3 to 5 days. Complete recovery takes about 4 to 6 weeks. Someone who gets a laparoscopic procedure or vaginal hysterectomy can usually go home the same day as the surgery, and recovery might be shorter and less painful.

Radical hysterectomy

This operation is not often used for uterine sarcomas but might be needed if the tumor appears to have spread to nearby tissues.

A radical hysterectomy removes the:

• Uterus
• Parametrium
• Uterosacral ligaments
• Upper part of the vagina near the cervix

It is most often done through an abdominal surgical incision or with a laparoscope, but it can also be done through the vagina. A robotic approach, in which the surgeon controls robot arms to operate, might be used as well.

A radical hysterectomy is done using general anesthesia. Most people having a radical hysterectomy also have some lymph nodes removed.

Because more tissue is removed by a radical hysterectomy than with a total hysterectomy, the hospital stay might be longer.

Possible side effects

After this surgery, a person cannot become pregnant and won’t have a menstrual period.

Complications associated with a radical hysterectomy can include:

• Bleeding
• Infection
• Damage to the urinary (bladder and ureters) or bowel systems
• Trouble urinating (this can happen if some of the nerves of the bladder are damaged)

Bilateral salpingo-oophorectomy (BSO)

A BSO removes both fallopian tubes and both ovaries. In treating uterine sarcomas, this operation is often done at the same time as the uterus is removed.

Possible side effects

If both of your ovaries are removed, you will go into menopause if you have not done so already. This can lead to vaginal dryness and pain during sex. These symptoms can be improved with nonhormonal treatments or vaginal estrogen treatment, although this isn't safe for everyone with uterine sarcoma and should be discussed with your cancer care team.

Lymph node surgery

Sometimes imaging tests might show enlarged lymph nodes, or the surgeon might be concerned that cancer has spread to the lymph nodes.

In this case, they might recommend a lymph node dissection or a lymph node sampling to remove or sample lymph nodes:

• In the pelvis
• Around the aorta, the main artery that runs from the heart down along the back of the abdomen and pelvis

This can be done through the same cut as the abdominal hysterectomy or laparoscopic hysterectomy. If a hysterectomy is done through the vagina, lymph nodes can be removed after the hysterectomy by a laparoscopic surgery.

These lymph nodes are checked to see if cancer cells have spread there.

Lymph node surgery and prognosis

Uterine sarcoma that has spread to lymph nodes is often associated with a poorer prognosis (outlook).

If uterine sarcoma hasn’t spread to lymph nodes, it’s not known if removing lymph nodes improves prognosis. Studies are being done to help answer this question.

Possible side effects

Removing lymph nodes in the pelvis can lead to a buildup of fluid in the legs, called lymphedema. This is more likely if radiation is given after surgery.

Learn more in Lymphedema.

Other procedures that might be done during surgery

Omentectomy: This procedure removes the omentum, which is a layer of fatty tissue that covers the abdominal organs like an apron. It might be done at the same time as the hysterectomy if cancer has spread there, or as a part of staging.

Peritoneal biopsies: This procedure removes small pieces of the peritoneum, the tissue lining the pelvis and abdomen, to check for cancer cells.

Pelvic washings: The surgeon rinses the abdominal and pelvic cavities with salt water (saline), collects it, and then sends the fluid to the lab to see if it has cancer cells.

Tumor debulking: The surgeon attempts to remove as much of the tumor as possible if cancer has spread throughout the abdomen. Debulking might help with symptoms or help treatments, like radiation or chemotherapy, work better.

Sexual impact of surgery

For some people, certain changes in hormones or body image after surgery can change how they view sex and experience pleasure. While physical and emotional changes can affect the desire for sex, these surgical procedures do not prevent a person from feeling sexual pleasure.

You do not need ovaries or a uterus to have sex or reach orgasm. Surgery can actually improve a person's sex life if the cancer had caused problems with pain or bleeding during sex.

Learn more in How Cancer Surgery Can Affect Sex for Women.