Laparoscopic Hysterectomy: Types, How Long It Takes, Risks and Recovery

A laparoscopic hysterectomy is an operation to remove the uterus through a few small cuts in the abdomen, using a thin camera and long, narrow instruments. It is often called keyhole or minimally invasive hysterectomy. Compared with open surgery through a larger abdominal incision, most people go home sooner and get back to their usual activities faster.^[1][2]

This guide explains how a laparoscopic hysterectomy is done, the different types, how long the operation takes, who is a good candidate, the risks to know about and what recovery usually looks like. If you are still deciding whether you need a hysterectomy at all, start with our overview of what a hysterectomy involves and the common reasons doctors recommend one.

What is a laparoscopic hysterectomy?

In a laparoscopic hysterectomy, the surgeon passes a laparoscope (a thin tube with a camera and light) through a small cut, usually in or near the belly button. The abdomen is gently inflated with gas so the surgeon has room to see and work. Instruments go in through two to four more small cuts in the lower abdomen, and the surgeon operates while watching a magnified image on a screen.^[3]

The uterus is then removed either through the vagina or, in some cases, through one of the small abdominal cuts. Most of these cuts are between about 5 mm and 1 cm long. You can see what the scars usually look like in our guide to hysterectomy scars and incisions.

Laparoscopic hysterectomy is done under general anesthesia, so you are asleep for the whole operation.^[3] It is used mainly for non-cancerous conditions such as fibroids, heavy bleeding, endometriosis and adenomyosis, and also for some early cancers of the uterus.^[2][4]

Types of laparoscopic hysterectomy

“Laparoscopic hysterectomy” is an umbrella term. The main versions differ in how much of the operation is done through the keyholes and what is removed.^[1]

Total laparoscopic hysterectomy (TLH)

The whole operation is done laparoscopically: the uterus and cervix are freed and removed, and the top of the vagina is closed with stitches from inside the abdomen. This closed top of the vagina is called the vaginal cuff. The uterus is usually taken out through the vagina.

Laparoscopic supracervical hysterectomy (LSH)

The uterus is removed but the cervix is left in place. This is a partial hysterectomy. Because the cervix stays, the uterus cannot come out through the vagina, so it is usually cut into smaller pieces inside the abdomen to remove it through a small incision (see morcellation below). If you keep your cervix, you still need regular cervical screening.

Laparoscopic-assisted vaginal hysterectomy (LAVH)

Part of the operation is done laparoscopically, often to free the upper attachments of the uterus or to deal with scar tissue, and the rest is finished through the vagina. We explain it in detail in our guide to LAVH.

Robotic, single-port and vNOTES variations

A robotic hysterectomy is a laparoscopic hysterectomy in which the surgeon controls the instruments from a console. Single-port surgery uses one slightly larger cut at the belly button instead of several small ones, and vNOTES passes the camera and instruments through the vagina. A Cochrane review found no evidence that robotic or single-port surgery gives better results than conventional laparoscopy for benign conditions.^[1]

Whether your ovaries and fallopian tubes are also removed is a separate decision from the type of surgery. Many surgeons now suggest removing the fallopian tubes even when the ovaries are kept, to lower the future risk of ovarian cancer. Removing the ovaries before menopause causes immediate menopause, so discuss this carefully; your surgeon can explain the effects.

How does laparoscopic surgery compare with other routes?

There are three main routes for a hysterectomy: vaginal, laparoscopic and abdominal (open). The American College of Obstetricians and Gynecologists (ACOG) recommends a minimally invasive approach whenever it is feasible. Among these, the vaginal route is preferred when it is possible, and laparoscopic surgery is the preferred alternative to open surgery when a vaginal hysterectomy is not suitable.^[2]

A 2015 Cochrane review of 47 randomized trials with 5,102 women compared the routes for benign conditions.^[1] Its main findings for laparoscopic surgery were:

• Compared with open surgery: return to normal activities about 13.6 days sooner, fewer fevers and wound infections, but a longer operation and more injuries to the bladder or ureters (the tubes from the kidneys to the bladder).
• Compared with vaginal surgery: no clear advantage. Laparoscopic surgery took longer, and total laparoscopic hysterectomy had more urinary tract injuries.

In practice, the vaginal route is not possible for everyone. A large uterus, a narrow vagina, previous surgery, scar tissue, endometriosis or the need to look at the ovaries can make laparoscopy the better choice. You can read more about the alternative in our guide to vaginal hysterectomy.

Who is a good candidate?

Most people who need a hysterectomy for a benign condition can have it laparoscopically. The final choice depends on the size and shape of the uterus and vagina, how far any disease has spread outside the uterus, other procedures you need at the same time, your general health, and the surgeon’s training and experience.^[2]

Laparoscopy may be harder or less suitable if:

• the uterus is very large, for example with big fibroids;
• there is heavy scar tissue (adhesions) from previous surgery, infection or severe endometriosis;
• you have serious heart or lung disease, because the gas used to inflate the abdomen and the head-down position on the operating table put extra strain on breathing and circulation;
• cancer is suspected and the uterus would have to be cut into pieces to remove it.

For early cancer of the uterine lining (endometrial cancer), a large trial found that laparoscopic surgery was safe and caused fewer complications than open surgery.^[4] For early cervical cancer, however, a major trial found lower survival after minimally invasive radical hysterectomy than after open surgery, so open surgery is usually recommended.^[5] Our article on hysterectomy for cervical cancer covers this in more detail.

What happens during the operation

Every hospital and surgeon works a little differently, but a total laparoscopic hysterectomy usually follows these steps:

1. Anesthesia and positioning. You are put to sleep and positioned on your back with your legs supported. A catheter is placed to drain your bladder, and a device called a uterine manipulator is placed through the vagina so the surgeon can move the uterus.
2. Small incisions and gas. The surgeon makes a cut near the belly button, inflates the abdomen with carbon dioxide gas and inserts the camera. Two or three more small cuts are made for the instruments.
3. Freeing the uterus. The surgeon seals and divides the ligaments and blood vessels that hold and supply the uterus, and carefully moves the bladder away from the cervix.
4. Removing the uterus. The uterus and cervix are separated from the top of the vagina and taken out, usually through the vagina.
5. Closing. The top of the vagina is stitched closed, the gas is released and the small skin cuts are closed with stitches, glue or small strips.

Sometimes the surgeon has to switch to open surgery during the operation, for example because of heavy scar tissue, bleeding or a very large uterus. This is called conversion. In a study of almost 7,000 laparoscopic hysterectomies in Michigan, about 4% were converted to open surgery.^[6] It is not a failure of the operation, but your consent form will usually mention the possibility.

What is morcellation?

When the uterus is too large to come out whole, or the cervix is being kept, the surgeon may cut it into smaller pieces to remove it. This is called morcellation. When it is done with an electric device inside the abdomen (power morcellation), there is a risk of spreading cancer cells if an unsuspected cancer is present. The US Food and Drug Administration (FDA) estimates that a hidden uterine sarcoma, a rare cancer, may be found in about 1 in 225 to 1 in 580 women having surgery for fibroids. The FDA advises using power morcellation only in carefully selected patients, inside a containment bag, and not in women over 50 having surgery for fibroids or in anyone with suspected or confirmed cancer.^[7] Ask your surgeon whether morcellation is planned and how it will be done.

How long does a laparoscopic hysterectomy take?

Most laparoscopic hysterectomies take between about one and three hours of operating time. In a large UK trial, the average was 72 to 84 minutes, compared with 39 to 50 minutes for vaginal or open surgery.^[8] In a series of more than 1,000 laparoscopic hysterectomies in a US health system, the median operating time was 150 minutes.^[9]

The time depends on the size of the uterus, scar tissue or endometriosis, whether the ovaries and tubes are removed, other procedures done at the same time, and the surgeon’s experience. Add time before and after for anesthesia and the recovery room, so you will usually be away from your family for several hours.

Benefits and risks

Benefits

• Shorter hospital stay and faster return to everyday activities than open surgery.^[1][2]
• Less pain after the operation and better short-term quality of life than open surgery.^[8]
• Fewer wound infections and fevers than open surgery.^[1]
• Small scars instead of one longer incision.
• The surgeon can see and treat other problems in the pelvis, such as endometriosis or adhesions, during the same operation.

Risks

Serious complications are uncommon, but every hysterectomy carries risks: bleeding, infection, blood clots, reactions to anesthesia and injury to nearby organs such as the bladder, ureters, bowel or blood vessels. Some risks are more specific to the laparoscopic route:

• Urinary tract injury. Injuries to the bladder or ureters were more common with laparoscopic than with open surgery in the Cochrane review.^[1] Most are found and repaired during the operation.
• Major complications in early trials. The UK eVALuate trial, published in 2004, found a higher rate of major complications with laparoscopic than with open hysterectomy (11.1% vs 6.2%).^[8] Surgical techniques and training have improved since then, and results depend heavily on the surgeon’s experience, so it is reasonable to ask how many of these operations your surgeon does.
• Vaginal cuff opening (dehiscence). Rarely, the stitched top of the vagina can open after a total hysterectomy. In a 10-year study at a large US hospital, this happened after 1.35% of total laparoscopic hysterectomies, more often than after other routes.^[10] This is one reason to avoid sex and anything inserted into the vagina until your surgeon says the cuff has healed.
• Conversion to open surgery, described above.^[6]
• Shoulder pain and bloating from the gas used during surgery. This is common, uncomfortable and temporary.^[11]

Recovery after laparoscopic hysterectomy

In the hospital

You wake up in the recovery area, where nurses check your pain, blood pressure and bleeding. Many people in the US go home the same day; others stay one night. In one US health system, about half of patients went home the same day, with low readmission rates.^[9] The NHS says most people leave the hospital between one and four days after a laparoscopic or vaginal hysterectomy.^[12]

The first weeks at home

• Pain and tiredness. Expect soreness around the small cuts, cramping and tiredness for the first one to two weeks. Shoulder pain from the gas usually settles within a few days.
• Bloating. Abdominal swelling is common for several weeks and usually settles gradually.
• Light vaginal bleeding or discharge is normal for a few weeks after a total hysterectomy.
• Walking from the first day helps prevent blood clots and speeds recovery. Increase activity gradually.
• Lifting. Avoid heavy lifting during the first weeks and follow your surgeon’s advice on when to return to it.^[12]
• Driving is usually possible once you can wear a seatbelt comfortably and make an emergency stop, often two to six weeks after surgery, and when you are no longer taking medicines that make you drowsy.^[12]
• Sex. Wait until any discharge has stopped and your surgeon is happy that the vaginal cuff has healed, usually at least four to six weeks.^[12]

Recovery after laparoscopic surgery is usually faster than the six to eight weeks often quoted for open surgery.^[12] Some people with desk jobs feel ready to go back to work within a few weeks, while the NHS gives six to eight weeks as a general guide for jobs without heavy lifting; ask your surgeon what is realistic for you and your work. Internal healing continues for weeks after you feel well. Our week-by-week recovery guide goes through each stage.

When to get medical help

Contact your surgeon or seek urgent care if you have:

• heavy vaginal bleeding or passing clots;^[12]
• a fever, or redness, swelling or pus around a cut;
• strong-smelling vaginal discharge;^[12]
• severe or worsening abdominal pain, a swollen, hard abdomen, or vomiting;
• pain or burning when passing urine, being unable to pass urine, or urine leaking from the vagina;
• a sudden gush of fluid from the vagina or a feeling of something pushing down, which can be a sign of cuff opening;
• pain, swelling or warmth in one leg;
• low mood that does not lift.^[12]

Call 911 if you have chest pain or sudden shortness of breath, which can be signs of a blood clot in the lungs.

Questions to ask your surgeon

• Why do you recommend the laparoscopic route for me rather than vaginal or open surgery?
• Will it be a total or a supracervical hysterectomy? Will my tubes and ovaries be removed?
• How many laparoscopic hysterectomies do you do each year, and how often do you need to convert to open surgery?
• How will the uterus be removed? Is morcellation planned?
• Will I go home the same day? What pain relief will I have?
• When can I drive, return to work, lift, exercise and have sex?

For practical preparation, see our recommendations before your hysterectomy.

Frequently asked questions

Is a laparoscopic hysterectomy major surgery?

Yes. The cuts are small, but the operation inside the body is the same as any hysterectomy, done under general anesthesia. Feeling well soon after surgery does not mean the internal healing is finished.

Will I go into menopause after a laparoscopic hysterectomy?

Only if your ovaries are removed before you reach natural menopause. If your ovaries are kept, they keep making hormones, although your periods stop. If you notice hot flashes or night sweats later on, mention them to your doctor.

Can a laparoscopic hysterectomy be done for a large uterus or fibroids?

Often, yes, in experienced hands. A very large uterus makes the operation longer and raises the chance of conversion to open surgery,^[6] and it may need to be cut into pieces to remove it. Your surgeon will decide based on imaging and an examination.

How many scars will I have?

Usually three to five small scars: one in or near the belly button and the others in the lower abdomen. Single-port surgery leaves one scar, hidden in the belly button. Most fade well over the following months.

Sources

1. Aarts JWM, Nieboer TE, Johnson N, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database of Systematic Reviews. 2015;(8):CD003677. pubmed.ncbi.nlm.nih.gov
2. American College of Obstetricians and Gynecologists. Committee Opinion No. 701: Choosing the route of hysterectomy for benign disease. Obstetrics & Gynecology. 2017;129(6):e155–e159. pubmed.ncbi.nlm.nih.gov
3. NHS. Hysterectomy: how it’s performed. nhs.uk
4. Walker JL, Piedmonte MR, Spirtos NM, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. Journal of Clinical Oncology. 2009;27(32):5331–5336. pubmed.ncbi.nlm.nih.gov
5. Ramirez PT, Frumovitz M, Pareja R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. New England Journal of Medicine. 2018;379(20):1895–1904. pubmed.ncbi.nlm.nih.gov
6. Lim CS, Mowers EL, Mahnert N, et al. Risk factors and outcomes for conversion to laparotomy of laparoscopic hysterectomy in benign gynecology. Obstetrics & Gynecology. 2016;128(6):1295–1305. pubmed.ncbi.nlm.nih.gov
7. US Food and Drug Administration. Power morcellation during gynecologic laparoscopic surgeries. fda.gov
8. Garry R, Fountain J, Mason S, et al. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ. 2004;328(7432):129. pubmed.ncbi.nlm.nih.gov
9. Perron-Burdick M, Yamamoto M, Zaritsky E. Same-day discharge after laparoscopic hysterectomy. Obstetrics & Gynecology. 2011;117(5):1136–1141. pubmed.ncbi.nlm.nih.gov
10. Hur HC, Donnellan N, Mansuria S, Barber RE, Guido R, Lee T. Vaginal cuff dehiscence after different modes of hysterectomy. Obstetrics & Gynecology. 2011;118(4):794–801. pubmed.ncbi.nlm.nih.gov
11. NHS. Laparoscopy (keyhole surgery). nhs.uk
12. NHS. Hysterectomy: recovery. nhs.uk

This article is for general information and is not a substitute for medical advice. The best type of hysterectomy depends on your diagnosis, anatomy and medical history, so always discuss your options with your own gynecologist or surgeon, and contact them or emergency services if you are worried about any symptom after surgery.