How it works: During the procedure, a small tube containing a telescope (laparoscope) and a tiny video camera will be inserted through a small cut (incision) in your abdomen. This allows the surgeon to see your internal organs. Instruments are then inserted through other small incisions in your abdomen or vagina to remove your uterus, cervix and any other parts of your reproductive system. These laparoscopic surgeries are usually carried out using general anaesthetic– where you'll be unconscious during the procedure..
Who is it usually recommended for?: Laparoscopic surgery is also known as keyhole surgery. It's the preferred way for most patients to remove the organs and surrounding tissues of the reproductive system.
Healing and Recovery: This method is the most common since it is the least invasive, and therefore has a shorter hospital stay and faster recovery time. There is also generally less pain and bleeding after the operation, and reduced scarring relative to abdominal surgery.
How it works: During a vaginal hysterectomy, the uterus and cervix are removed through an incision that's made at the top of the vagina. Special surgical instruments are inserted into the vagina to detach the uterus from the ligaments that hold it in place. After the uterus and cervix have been removed, the incision will be sewn up. The operation usually takes about an hour to complete. A vaginal hysterectomy can either be carried out using general anesthetic – where you'll be unconscious during the procedure.
Who is it usually recommended for?: A vaginal hysterectomy is usually preferred over an abdominal surgery as it's less invasive.
Healing and Recovery: Because this method is less invasive than abdominal surgery, it generally involves a shorter stay in the hospital, and the recovery time tends to be quicker than abdominal surgery. There is less scarring relative to abdominal surgery.
Laparoscopic Assisted Vaginal Surgery
This approach combines both techniques of a laparoscopic and vaginal approach. This may be the preferred approach for some gynecologists and has the same benefits of a purely laparoscopic approach.
How it works: During abdominal surgery, an incision will be made in your abdomen. It will either be made horizontally along your bikini line or vertically from your belly button to your bikini line. A vertical incision will usually be used if there are large fibroids (non-cancerous growths) in your uterus, or for some types of cancer. After your uterus and/or ovaries have been removed, the incision is stitched up. The operation takes about two hours to perform and a general anesthetic is used.
Who is it usually recommended for? An abdominal hysterectomy may be recommended if your uterus is enlarged by fibroids or pelvic tumors and it's not possible to remove it through your vagina.
Healing and Recovery: Abdominal surgery is the most invasive method, and may result in more delayed recovery times and scarring.
Further reading about different approaches and their relative risks and benefits: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC558455/
Visit www.iapmd.org/surgery for lots of evidence-based information and resources for those considering, going through or recovering from surgery for PMDD/PME.