Abdominal hysterectomy involves removal of the uterus through an incision on the lower abdomen. Vaginal hysterectomy involves removal of the uterus via the vagina, with no abdominal incision. Laparoscopic hysterectomy involves 'keyhole surgery' with small incisions on the abdomen. In laparoscopic hysterectomy, the uterus is removed with the aid of a surgical telescope (laparoscope) inserted through the umbilicus (belly button) and instruments inserted through two or three further keyholes. Laparoscopic hysterectomy may be further subdivided depending on the extent of the surgery performed laparoscopically compared to that performed vaginally. More recently, laparoscopic hysterectomy can be performed with the use of a so-called robot which is operated from a distance by the surgeon.
Vaginal hysterectomy should be performed in preference to abdominal hysterectomy, where possible. This review found that vaginal hysterectomy meant quicker return to normal activities, fewer infections and episodes of raised temperature after surgery, and a shorter stay in hospital compared to abdominal hysterectomy.
Laparoscopic hysterectomy meant quicker return to normal activities, less blood loss and a smaller drop in blood count, a shorter stay in hospital, and fewer wound infections and episodes of raised temperature after surgery compared to abdominal hysterectomy, but laparoscopic hysterectomies have a greater risk of damaging the bladder or ureter (the tube leading to the bladder from the kidney) and are longer operations.
No benefits were found for laparoscopic versus vaginal hysterectomy. Laparoscopic hysterectomies are longer operations associated with a higher rate of substantial bleeding.
The authors concluded that vaginal hysterectomy should be performed in preference to abdominal hysterectomy, where possible. Where vaginal hysterectomy is not possible, a laparoscopic approach may avoid the need for an abdominal hysterectomy. Risks and benefits of different approaches may however be influenced by the surgeon's experience. More research is needed, particularly to examine the long-term effects of the different types of surgery.