Hysterectomy: What Women Need to Know About Surgical Options, Legal Rights, and Medical Malpractice Risks

This article is intended to help Women make informed decisions about their health and hysterectomies by understanding their surgical options, the risks of the procedure, recovery issues, consent form issues, and your rights when undergoing a hysterectomy procedure. It is important to remember that the choice to undergo a hysterectomy is entirely yours, and not anyone else’s, including your doctor. If you don’t want to undergo the procedure, then you don’t have to. It’s your body, and ultimately your choice. You do have other non-surgical options available to you which you may want to explore. Also, if in doubt, you are always entitled to get a second opinion from another gynecology surgeon at a different medical facility. Sometimes this is an excellent idea, it will offer you more information and give you the confidence you need to move forward with your decision, even if you like your gynecologist and think that they are great. There is nothing wrong in consulting with another doctor for additional information and another viewpoint. In fact, it’s probably a wise decision to consult another surgeon in another facility.

The Female Anatomy

The female uterus nourishes and protects the baby during development. The fallopian tubes serve as the pathway for the egg and help during the fertilization process. While the ovaries release the eggs during ovulation (once per month in a typical cycle) produce hormones, estrogen and progesterone, which regulate the menstrual cycle, support pregnancy, and influence your overall health (bone, heart, etc.). The hysterectomy procedure involves the removal of one, some or all of these important organs.

Reasons Why Women Get Hysterectomies

Women get hysterectomy procedures due to fibroids, endometriosis, pain, cancer, and abnormal vaginal bleeding (Menorrhagia). Doctors can use a variety of tests to diagnose uterine cancer and endometrial cancer including taking a medical history, a doing a physical examination, performing a transvaginal ultrasound, taking an Endometrial Biopsy (taking a sample of the uterine lining which is examined for cancer cells), performing a Dilation and Curettage (D&C) (often with hysteroscopy) to get a better tissue sample, sending you out to undergo Diagnostic Imaging (like CT Scans, MRIs, and PET scans), and performing Blood Tests (CA-125). Even if you have uterine or endometrial cancer, surgery (usually a hysterectomy) is the preferred procedure to definitively treat and fully stage the disease.

Does My Fibroid Contain Cancer?

As for fibroids, there currently are no diagnostic tests available for doctors to use to determine whether your fibroid contains cancer, pre-operatively. The only way for the doctor to know if your fibroid is cancerous is to remove it, send it to a laboratory and have a pathologist (a doctor) look at it under a microscope. If your doctor ever tells you any time before surgery that your fibroid is cancerous and that you need a hysterectomy, immediately leave and go to another gyn doctor somewhere else. The reason is because there is no way a doctor can definitively say your fibroid is cancerous without a biopsy. Your doctor can say he feels the fibroid may be suspicious of cancer, but he may be wrong too. There is no way today any doctor can tell you that you definitely have cancer in your fibroid without performing surgery and a biopsy on the fibroid tissue.

Types of Hysterectomies

Let us start with the basics. There are four basic types of hysterectomy procedures, categorized by how much of the reproductive system is removed, not how the surgery is performed. Understanding these procedures is helpful when discussing your options with a gynecology surgeon.

1. Total Abdominal Hysterectomy

This usually involves the removal of the uterus and cervix. The ovaries and fallopian tubes may or may not be removed (that’s a separate decision and discussion that you should have with your doctor).

2. Subtotal (or Supracervical) Hysterectomy

This usually involves the removal of the uterus, but the cervix is left intact. This procedure is sometimes chosen to preserve pelvic floor support or sexual function, though evidence is mixed. This procedure is not considered suitable if there is any risk of cervical cancer or abnormal Pap smears.

3. Radical Hysterectomy

This usually includes the removal of the uterus, cervix, the upper part of the vagina and surrounding tissues, including the lymph nodes. This procedure is used primarily for gynecological cancers (like cervical or endometrial cancer), and is more extensive and complex than the other procedure types.

4. Total Hysterectomy with Bilateral Salpingo-Oophorectomy (BSO)

This usually involves removal of the uterus, cervix, both ovaries and both fallopian tubes. This procedure is often done when there is a high risk of ovarian cancer (i.e., BRCA mutation). This procedure will result in immediate (“shock”) menopause if ovaries are removed before natural menopause.

Surgical Approaches Used

In addition to the four different hysterectomy procedures, there are different types of hysterectomy surgical approaches or procedures. These are the surgery procedures used by gynecology surgeons to remove the female reproductive organs. They include:

a. Total Abdominal Hysterectomy (TAH)

• Large open incision (typically horizontal, similar to a C-section)
• Longer recovery time (from 6-8 weeks)
• Typically used in complex cases (e.g., cancer, large uterus)

b. Mini-Laparotomy

• A smaller incision than a full TAH (usually 2–4 inches)
• Moderate recovery time
• Less invasive but still considered open surgery

c. Laparoscopic Hysterectomy

• Small incisions in the abdomen for camera and instruments

Variants:

• Conventional Laparoscopic
• Robot-assisted (e.g., Da Vinci System)
• Uterus removed vaginally or via hand morcellation in a containment bag
• Shorter recovery (~2–4 weeks)
• Minimal visible scarring (keyhole incisions)

d. Vaginal Hysterectomy

• No external scars
• Performed entirely through the vagina
• Fast recovery (about 2–4 weeks)
• Ideal for smaller uterus (less than 250 grams in weight) and non-complex cases

Surgical Removal of the Uterus

The other issue that every woman should consider and thoroughly discuss with their Gynecology Surgeon is how the uterus is going to be surgically removed. There are several different ways a gynecologist can remove your uterus. It is important for you to know how your uterus is going to be removed, discuss it with your doctor, and agree on a method that you want performed. These include the following:

a. Vaginal Extraction

A surgeon manually removes your uterus through your vaginal canal. There are no abdominal incisions, and this procedure is limited to smaller uterus sizes. The uterus typically weighs 250 grams and less.

b. Hand Morcellation in Containment Bag

A surgeon manually places your uterus in a bag which extrudes out of the abdominal incision, but the bag itself is usually contained within your abdomen. The surgeon then cuts the uterus while it is still inside the bag into smaller pieces. This method is used to prevent the accidental spread of potentially cancerous uterine tissue inside your abdomen. This method prevents the accidental spread of undiagnosed cancerous tissue. This and the En Bloc uterus removal methods are oncologically preferred to prevent the spread of undiagnosed cancer.

c. Power Morcellation

A surgeon uses a power morcellator, or a mechanical device that chops up the uterine tissue for removal. The use of open power morcellator devices has been prohibited by the FDA. Under limited circumstances, a gynecology surgeon could use a power morcellation device with an approved containment bag. The FDA has issued warnings against the use of power morcellation because there is a risk of spreading hidden uterine cancer. Moreover, there are less risky alternatives readily available for removing your uterus. Power morcellation should be totally avoided.

d. Open Incision (En Bloc Removal)

Under this method, a surgeon removes the entire uterus intact through a large abdominal incision. This is the preferred method when the uterus is large (greater than 250 grams) or when the gynecology surgeon suspects or confirms during the surgery that the fibroid or uterus contains cancer.

Removal of Ovaries and Fallopian Tubes

For some women, they insist on retaining their ovaries and fallopian tubes. There are many good reasons to do so. One of which is that when you remove them, you can go into surgical menopause, or shock menopause. That is when your body is no longer producing estrogen. This can cause sudden and severe onset of hot flashes, night sweats, vaginal dryness, mood swings, and sleep disturbances. Shock menopause can also result in long term consequences such as increased risk of osteoporosis, heart disease, and cognitive impairments. The retention of these critical organs should also be thoroughly discussed with your surgeon and well documented in your medical chart.

Permanent Abdominal Scarring

Every woman should consider and evaluate the permanent scarring left by each of these surgical procedures.

A total abdominal hysterectomy: The surgeon will leave a large horizontal or vertical scar on your abdomen (much like a C-Section).

Mini-laparotomy: The surgeon will leave a smaller lower abdominal scar (approximately 2–4 inches in length).

Laparoscopic/Da Vinci procedure: The surgeon will leave anywhere from 3 to 5 tiny scars (typically less than 1 cm) which are often located in the lower abdomen and near the navel.

Vaginal extraction: The surgeon removes the uterus through the vaginal canal and there are usually no external scars left on your abdomen.

You should discuss the permanent scarring to your body with your surgeon, and make sure that you and your surgeon are on the same page so there are no surprises and you agree to scarring. Your discussions about permanent scarring should also be documented in your medical chart by your gynecologist.

Informed Consent: Know Your Rights

Informed Consent is not just a piece of paper, but an extensive discussion that you have with your gynecology surgeon to discuss the nature of your condition, the mutually agreed upon surgical methods that the doctor is going to use to perform your hysterectomy, your selected procedure, and the method you decide to have the doctor use to remove your uterus, and the permanent scarring resulting from that procedure. Your consent should reflect only those surgical procedures and methods that you agree to and approve of for your surgery.

Ask to Take the Consent Form Home and Read It, If Possible

I would suggest that you ask the gynecology surgeon for a copy of all consent forms BEFORE HAND so that you can carefully review them in advance at home. This way you know what the standard form says, and what blanks need to be filled in on that form when you go to meet with the doctor in their office. If you receive the consent forms while at the doctors office for the first time, you should read them all very carefully and make sure that they expressly state the surgical approach, and the surgical procedure that will be used to remove your uterus. In addition, you should not permit the doctor or nurse to leave any areas open or blank. You should cross those sections out and fill in the relevant ones that apply to your selected procedures. Also do not let the doctor or nurse insert any other additional procedures that you do not authorize such as ovary or fallopian tube removal, bladder suspension, etc. Unless of course, you have discussed them with your doctor, and you approve that they be performed.

Ask for a copy of your signed consent form, or better yet, take a photograph of it after you sign it with your cellphone. This will prevent anyone from inserting in the form any procedures you either didn’t agree to or altering the form after you have signed it.

Recovery Timeline Comparison

Another issue you should consider is how long will it take for you to recover from the procedure, how long will you have to remain in the hospital, and how much pain will you need to endure. All of these factors need to be considered when deciding which is the best hysterectomy procedure for you.

Documentation

You should also make sure that the doctor properly documents in your medical chart the discussions that you had regarding the hysterectomy procedure that you select, the method used to remove your uterus, and your instructions to not remove the ovaries and fallopian tubes. Under the law of most US jurisdictions, the medical records belong to you, not the doctor, and you also have the right to obtain a copy of those medical records at any time. It may be a good idea to ask the doctor for a copy of your medical chart BEFORE you undergo a hysterectomy. This way you can read them and make sure that the surgeon is on the same page with you when it comes to performing your hysterectomy.

Conclusion

It is your body, and with that you have the power to accept or reject any recommendations for surgery made by any doctor, including a hysterectomy. I tell everyone that you need to be your own medical advocate, ask questions and understand the process, procedures and potential outcomes. Every woman’s body is unique, and there is no one size fits all approach to medicine. You need to explore your best surgical options that fit your health needs, and personal preferences. If you are not satisfied with the answers you are getting, you can always get a second opinion from another gynecology surgeon. Remember, don’t be afraid to ask questions. The stupid question is the one you didn’t ask. With that anecdote, I’ve enclosed a list of questions that you may want to use when you meet with your gynecology surgeon to discuss your proposed hysterectomy procedure.

Here’s a well-rounded checklist of questions for women considering a hysterectomy. These questions help clarify the necessity, options, risks, post-op expectations, and consent boundaries, so you can make fully informed decisions and advocate for yourself.

Pre-Hysterectomy Checklist: Questions to Ask Your Surgeon

Understanding the Need

• Why are you recommending a hysterectomy in my case?
• Are there any non-surgical or less invasive alternatives I could consider first?
• Will this procedure address the cause of my symptoms definitively?
• What happens if I choose not to have surgery right now?

Surgical Approach & Details

• What type of hysterectomy are you recommending (abdominal, laparoscopic, vaginal)?
• Will my cervix be removed (total vs. subtotal hysterectomy)?
• Will you also be removing my ovaries or fallopian tubes? If so, why?
• Can you walk me through what the actual surgery will involve?
• How will my uterus be removed (vaginally, morcellation, intact, etc.)?
• Are you using a robot-assisted system (like Da Vinci), and why?
• Do you have a specialty in terms of hysterectomies? How often do you do my procedure and when is the last time you did one?

Risks & Complications

• What are the most common complications or risks of this surgery?
• What is the risk of organ injury (bladder, bowel, etc.)?
• If something unexpected happens during surgery, what would you do?
• What are the chances I’ll need a blood transfusion?

Power Morcellation & Cancer Risk

• Will hand or power morcellation be used? If so, how will the tissue be contained?
• How do you screen for hidden cancers (like uterine sarcoma) before surgery?

Consent & Surgical Boundaries

• What exactly will be written on the surgical consent form?
• Can I review and approve the form before the day of surgery?
• Will the consent specify only the procedures I agree to?
• Can I decline removal of my ovaries or other organs unless absolutely necessary?
• If a complication arises, how will you ensure I am consulted if possible?

Recovery & Post-Op

• What should I expect during my recovery? (pain, bleeding, mobility)
• How long will I need to be off work or limit physical activity?
• When can I drive, return to exercise, or resume sex?
• Are there signs of complications I should watch for at home?
• What type of scarring should I expect?
• Fertility: Will it be possible to have children after the procedure?
• Sexuality: How might the surgery affect sexual function and desire? Will it impact orgasmic perception? Are there solutions for issues like vaginal dryness?

Communication & Follow-Up

• Who will be performing the surgery? (Will a resident or assistant be involved?)
• How do I contact you or your team if I have questions after surgery?
• Will I have a follow-up appointment, and when?
• Emotional support: Can you talk to other women who have had the surgery? Is there a support group available?
• Grief: Is it normal to feel a sense of loss or grief after the procedure, even if you didn’t plan on more children?

Insurance & Costs

• Is this procedure fully covered by my insurance?
• Are there any out-of-pocket costs I should be aware of?

Optional: Bring This to Your Appointment

• Bring a notebook or ask if you can record the conversation (with permission).
• Bring a trusted person to help take notes or advocate for you.
• Ask for everything in writing, including consent and recovery instructions.

I hope that you find this article helpful in advocating for yourself and in deciding whether to undergo a hysterectomy procedure. This article is meant to put knowledge and power into your hands so you can ask the right questions, and choose the best path for your medical care.

With best success and wishes for your health,

MICHAEL GUNZBURG, ESQ.

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