There are three different methods:
A cut is made in the lower abdomen to expose the tissues and blood vessels that surround the uterus and cervix. These tissues are cut and the blood vessels are tied off to remove the uterus. Stitches are placed in these deep structures, which will eventually dissolve and do not need to be removed. The uterus is removed from the top of the vagina and the vagina is closed to prevent infection and to keep the intestines from dropping downward.
The vagina is stretched and kept open by special instruments; no external incision is made. The doctor does, however, make an internal incision at the top of the vagina around the cervix. The uterus and cervix are cut free from their supporting ligaments and surrounding tissue, and connecting blood vessels are tied off. The uterus and cervix are removed through the vagina, which is then closed to prevent infection and to keep the intestines from dropping downward.
Laparoscopically assisted vaginal hysterectomy (LAVH):
A laparoscope is inserted through a small cut near the navel. This small, telescope-like device, about the width of a pencil, with a light on one end and a magnifying lens on the other, helps the doctor see the pelvic organs. The abdomen is inflated with carbon dioxide to improve your doctor's visibility and provide room to work. Images from the laparoscope are viewed on a special monitor.
Other small 1/4 to 1/2 inch wide incisions are made in the abdomen, through instruments are inserted to help move organs and remove the uterus. An incision is also made where the uterus joins the vagina. The bladder and rectum are gently pushed off the uterus, which is removed through the cut made in the vagina. The vagina is closed to prevent infection and to keep the intestines from dropping downward. The cuts are all closed with stitches, which will likely leave small scars.
With each procedure, a vaginal packing dressing is placed in the vagina. This will be removed after a day or two.
Vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy (LAVH) can be done if the stage of the cancer is very low. Abdominal hysterectomy permits careful removal of more tissue. This procedure is used when the stage is relatively higher.