A laparoscopic hysterectomy is a minimally invasive surgery to remove the uterus through several small incisions in the abdomen, each typically less than a centimeter wide. Instead of a large open cut, the surgeon inserts a tiny camera and specialized instruments through these small openings, using a video feed to guide the operation. Most people go home the same day and recover in two to four weeks, roughly half the time needed after traditional open surgery.
Why It’s Performed
The most common reason for any hysterectomy is symptomatic fibroids, accounting for about 51% of cases. Abnormal uterine bleeding that hasn’t responded to other treatments follows at nearly 42%, then endometriosis at 30% and uterine prolapse at about 18%. Some of these overlap, meaning a person may have more than one condition driving the decision.
A vaginal hysterectomy (no abdominal incisions at all) is generally the first choice when it’s feasible. But conditions like severe endometriosis, significant scar tissue from prior surgeries, or a uterus enlarged by fibroids can make the vaginal route impractical. In those situations, a laparoscopic approach is the preferred alternative to open abdominal surgery, offering smaller incisions, less blood loss, and a faster return to daily life.
Types of Laparoscopic Hysterectomy
Not all laparoscopic hysterectomies are the same. The differences come down to how much of the uterus is removed and whether part of the procedure happens vaginally.
- Total laparoscopic hysterectomy (TLH): The entire uterus, including the cervix, is detached and removed through the small abdominal incisions or through the vagina. The vaginal cuff (the top of the vagina where the cervix used to be) is sutured closed laparoscopically.
- Laparoscopic supracervical hysterectomy (LSH): Only the upper body of the uterus is removed, leaving the cervix in place. Some people prefer this option for its potential to preserve pelvic floor support, though you’ll still need routine cervical screening afterward.
- Laparoscopic-assisted vaginal hysterectomy (LAVH): The surgeon uses the laparoscope to detach the upper structures, then completes the rest of the operation vaginally, removing the uterus and cervix through the vaginal canal.
Your surgeon will recommend a specific type based on the reason for surgery, the size of your uterus, and whether the ovaries or fallopian tubes also need to be removed.
How the Surgery Works
The procedure is performed under general anesthesia, which means you’re fully unconscious and a breathing tube is placed for the duration. The operation typically involves three to four small incisions: one near the belly button for the camera and two or three on either side of the lower abdomen for the surgical instruments.
Once the incisions are made, the surgeon inflates the abdomen with carbon dioxide gas to create a working space. This gas is kept at a carefully controlled pressure so there’s enough room to see and maneuver without putting unnecessary strain on your body. The surgeon then identifies critical structures, particularly the ureters (the tubes connecting the kidneys to the bladder), before cutting any tissue.
From there, the blood supply to the uterus is sealed and divided, the uterus is separated from the surrounding ligaments and the bladder, and a circular incision is made at the top of the vagina to free the uterus completely. If the fallopian tubes are being removed (which is increasingly common to reduce future cancer risk), that’s done early in the procedure. If the ovaries are being kept, they’re carefully separated from the uterus while preserving their blood supply. The uterus is then removed either through the vagina or through the belly button incision in a protective bag, and the vaginal cuff is stitched closed.
Robotic-Assisted Laparoscopic Hysterectomy
Some surgeons perform the procedure using a robotic surgical system, where the surgeon sits at a console and controls robotic arms that hold the instruments. The robot provides a 3D, high-definition view with up to 15 times magnification and instrument tips that can rotate and bend more precisely than a human wrist. This constant steadiness can be especially helpful during long operations, in people with obesity, or when significant scar tissue makes the surgery more complex.
The tradeoff is time. Robotic-assisted procedures generally take longer to complete than other methods. The incisions, recovery, and risks are otherwise similar to a standard laparoscopic hysterectomy.
Risks and Complications
Laparoscopic hysterectomy is considered safe, but like all surgery, it carries risks. These include bleeding, infection, blood clots, and reactions to anesthesia. The most frequently cited concern specific to this approach is accidental injury to the bladder or ureters, since these structures sit close to the uterus.
The actual rate of ureter injury depends heavily on the surgeon’s experience. A study of nearly 2,400 laparoscopic hysterectomies performed by fellowship-trained minimally invasive surgeons found only one ureter injury, a rate of 0.04%. By contrast, the broader national rate is higher. With roughly 600,000 hysterectomies done annually in the U.S., that difference translates to an estimated 240 ureter injuries at high-volume centers versus nearly 4,700 at the national average. Surgeon experience and case volume matter significantly.
What Recovery Looks Like
Most people leave the hospital the same day. The small incisions heal quickly, and the initial soreness from the gas used to inflate the abdomen (which can cause temporary shoulder or chest discomfort as it’s absorbed) usually fades within a few days.
For the first week, plan on resting at home. You won’t be able to drive for at least a week, and not at all while taking prescription pain medication. Walking is encouraged from day one and helps reduce the risk of blood clots.
The biggest restriction is lifting. For six weeks after surgery, you should avoid lifting anything heavier than 10 pounds. That means no carrying groceries, laundry baskets, children, or pets, and no vacuuming or pushing heavy doors or carts. Nothing should be placed in the vagina for at least six weeks either, including tampons. This waiting period allows the vaginal cuff to heal fully and reduces the risk of it reopening.
Full recovery, meaning you feel back to normal and can resume all activities without restriction, takes two to four weeks for most people. That’s roughly half the six to eight weeks typically needed after open abdominal hysterectomy.
Long-Term Effects on Pelvic Health
One concern people have about hysterectomy is its effect on the pelvic floor over time. A large nationwide cohort study found that hysterectomy in general is linked to a higher incidence of pelvic organ prolapse, particularly beyond 10 years. However, the risk was not evenly distributed across all types. Laparoscopic hysterectomy and supracervical hysterectomy (where the cervix is preserved) were not associated with an increased risk of prolapse. Total hysterectomy, particularly by open approach, carried the higher risk.
Stress urinary incontinence is another long-term consideration. Studies looking at outcomes beyond a decade found a roughly 2.4 times higher likelihood of stress incontinence after hysterectomy. Pelvic floor exercises before and after surgery can help reduce this risk, and it’s worth discussing with your surgeon if you already experience any bladder leakage.