Hysterectomy, or removal of the uterus, is the second most common surgery among women, trailing only childbirth by cesarean section. A morcellator is sometimes used to cut the tissue into pieces for easier removal, but concerns are growing over the fact that morcellation can spread undetected cancer in the body. The main options for women include:
•Abdominal hysterectomy. Doctors remove the uterus intact, with rare exceptions, through at least a 5-inch incision in the lower part of the belly. The procedure has a longer recovery time, a larger scar and a higher risk of death than laparoscopic surgery, but it avoids the cancer risk associated with morcellation. It is usually chosen in cases of large pelvic tumors, adhesions or cancer.
•Laparoscopic hysterectomy. Doctors make three to four small cuts in the abdomen and insert a laparoscope that allows them to see the pelvic organs and work with other surgical instruments. When the uterus is too large to be taken out intact, or the cervix is to be retained, physicians use a morcellator or a scalpel to cut up the uterus.
•Vaginal hysterectomy. Doctors make a cut inside the vagina, remove the uterus and close the incision with stitches. Research suggests the procedure is associated with comparable or better results and fewer complications than laparoscopic or abdominal hysterectomies, but not all women are appropriate candidates. It can involve morcellation if the organ is too large to be removed whole.