You’ve gone through the hard process of deciding which gynecologic surgical option is best for your cancer risk reduction - hysterectomy, oophorectomy, or saplingo oophorectomy (sometimes call BSO, adding the word “bilateral” in front of it) - and are now ready to schedule your surgery. But which approach will your surgeon suggest, and why?  

Each of these surgeries can be performed in one of three ways - laparoscopic, open (abdominal), or vaginal - and comes with its own implications. The decision is highly individualized and should be made collaboratively between you and your surgical team, taking into account your medical history, cancer stage or risk, and personal preferences. (If you haven’t already,  read our piece first on understanding gynecological surgical options for breast cancer patients, survivors, and BRCA carriers, which also includes information on the hormonal implications of having these organs removed). 

In this post, we’ll explore the various surgical approaches, what to expect after surgery, and helpful recovery tips.

Laparoscopic Surgery

Laparoscopic surgery is a minimally invasive procedure often recommended for early-stage cancers and risk-reducing surgeries, such as those for individuals with high genetic risk like BRCA  (or other reproductive cancer gene) mutations. It involves small incisions through which a camera and surgical instruments are inserted. During the surgery, a small incision is made near the belly button to insert a laparoscope, and carbon dioxide gas is used to inflate the abdomen, creating more space for the surgeon to work. Additional small cuts are made to insert surgical instruments for removing the uterus, ovaries, and/or fallopian tubes.

Once the procedure is complete, the carbon dioxide gas is released, and the body absorbs it naturally. Any sutures used will either dissolve or need to be removed by your doctor within 7 to 10 days. Skin glue or steri-strips may also be used, which fall off on their own. Sometimes, robotic-assisted laparoscopic procedures are recommended when the surgeon needs enhanced precision, control, and visualization, especially for complex cases involving large fibroids, scar tissue, or delicate dissection near high-risk organs. 

Quick Takes:

• Scarring: 3-4 small scars (approximately 0.5–1 cm) typically on the lower abdomen, often near the belly button and at the bikini line
  

• Surgery Time: Typically 1-4 hours depending on which, or all, of the procedures you have

• Recovery Time: Generally 2-4 weeks
  

• Side-effects of Carbon Dioxide Gas: I was not warned about this in advance, so want to make sure you know! After this surgery, the residual gas can cause discomfort and pain, including bloating, gas pain, and referred pain in the shoulder or abdomen. This discomfort usually resolves within a few days, and gentle movement and walking, or over-the-counter pain relief (if approved by a doctor) may help alleviate symptoms. 

• Outpatient: This procedure usually does not require a hospital stay, with exceptions for higher risk patients 

Open (Abdominal) Surgery

Open (Abdominal) Surgery: Most invasive, longest recovery time, biggest scars

For those with certain gynecological cancers or genetic mutations like BRCA, an open (abdominal) hysterectomy and/or oophorectomy may be preferred over laparoscopic surgery, especially if the cancer is advanced, involves large tumors, or requires better access than laparoscopic tools can provide. Open surgery is also recommended for individuals with previous surgeries, obesity, or significant scar tissue from conditions like endometriosis. Additionally, if a thorough examination of the abdominal cavity or surrounding tissues is needed to check for cancer spread, open surgery is more appropriate. 

During an open abdominal hysterectomy, the surgeon begins by making a horizontal or sometimes vertical incision above the pubic bone. They carefully separate the abdominal muscles and tissues, cutting through the skin, subcutaneous fat, fascia, and rectus muscles to access the uterus. The fascia, a strong connective tissue that supports the abdominal organs, is cut along with the muscles, which are typically separated to provide access to the pelvic cavity.

The uterus is detached from surrounding structures and removed; if the ovaries and/or  fallopian tubes are being removed, they then follow. Once the organs are removed and bleeding is controlled, the surgeon closes the incision with sutures or staples.

Quick takes: 

• Scarring: A horizontal scar (bikini line) or vertical scar on the lower abdomen, depending on the incision type, that can range from  4 to 12 inches
  

• Surgery Time: Typically 1 to 4 hours, depending on which, or all, of the procedures are performed
  

• Recovery Time: Generally 4-6 weeks; however, in some cases it can take up to 12
  

• Hospital stay: 2-5 days 

Vaginal Surgery

Vaginal Surgery: Least invasive, less scarring, may be easier for some women

A doctor may recommend a vaginal hysterectomy or oophorectomy over laparoscopic or open surgery if you have specific conditions or anatomical factors that make vaginal surgery more suitable - for example, a history of pelvic or abdominal surgeries, scar tissue, or conditions like endometriosis. Vaginal surgery is also often preferred when cancer or cancer risk, such as with the BRCA gene, is localized to the reproductive organs, as it allows for a more direct removal with minimal disruption to surrounding tissues. It may also be necessary, for example, if the uterus is removed during vaginal surgery but the ovaries are positioned too high to be removed through that approach. During the surgery, the organs will be removed through the vaginal canal- a small incision is made at the top of the vaginal canal, and the surgeon carefully detaches and removes the organs, then closes the incision with dissolvable stitches.

Quick Takes:

• Scarring: No visible external scars; may leave internal scars as part of the body’s healing process which generally don’t interfere with normal function
  

• Surgery time: Typically 1-4 hours depending on which, or all, of the procedures you have

• Recovery Time: Generally  3-6 weeks
  

• Hospital stay: 1-2 days

Recovery: What to Expect and Have on Hand 

First and foremost, always follow your surgeon’s instructions for eating, drinking, bathing, and activity levels during recovery. 

Here are some tips:

• Clear your schedule for rest: Downtime is a key component of your recovery. Prepare your streaming “watchlist,” line up the books you've been wanting to read—this is your time to rest. Fatigue and weakness are common after surgery, and recovery time can range from person to person. 

• Hydrate: Keep a water bottle  ready, and handy at all times. Hydration helps with constipation and overall recovery.

• Avoid Strenuous Activities: Refrain from heavy lifting or strenuous activity for several weeks.

• Watch for Signs of Infection: Watch for signs of infection such as redness, swelling, or drainage from incisions. If you experience fever, chills, or increased pain, seek medical attention.

• Loose-fitting Clothing: You’re not going to want anything tight on your abdomen area - so loose-fitting pj’s, robes, sweatpants, and oversized pants and shirts will be your best friends! Once you’re able to wear undergarments, look for styles without seams or tight elastic in the incision area. 
  

What to prepare for: 

Constipation: Constipation may occur, especially from residual gas from laparoscopy. Eating fiber-rich foods and drinking fluids can help. Start taking a stool softener (with your doctor’s approval) as soon as possible to avoid discomfort.

Pain Management: Have prescribed pain medication ready and take all medications as prescribed by your doctor. Take pain medication as soon as you feel discomfort, as it may take 30-45 minutes to take effect. For mild to moderate pain, Tylenol or Extra Strength Tylenol may be effective.

Possible Bleeding: Minor vaginal bleeding, discharge, or spotting is normal.  Heavy or persistent bleeding should be reported to the doctor. Report foul-smelling discharge to your doctor.

Mild Discomfort: Mild discomfort and irritation around your incisions and in the vaginal area are normal, and should gradually lessen with time.If pain increases, or your pain medication is no longer effective, call your doctor. 

Possible Hormonal Changes: When ovaries are removed, it puts you into surgical menopause, as it removes the body’s main source of estrogen. Please see our post on understanding surgical options for breast cancer patients, survivors, and BRCA carriers for more information on this. If you are cleared for HRT estrogen, you may wake up with an estrogen patch on – but this is usually discussed beforehand. If you’re not able to take estrogen systemically, you may be able to use localized estrogen cream, suppositories or a DHEA suppository like Intrarosa to compensate for the loss of estrogen once you’re healed.

Lymphedema: If lymph nodes are removed during your surgeries there is the possibility of developing lymphedema in the abdomen; check with your physician to see if compression garments are appropriate for you. Physical therapy and exercises to stimulate lymphatic function in the region can aid greatly in your recovery, and you may find this video from The Cancer Rehab PT helpful.

Choosing the right surgical approach is a personalized decision, and there are many factors to consider (read our Hysterectomy & Oophorectomy 101 article for more background). Whatever path you take, we hope that providing you with knowledge, preparation tips, and guidance on what to expect can help ease a little of the stress and help ensure the best possible outcome as you go through this particular stage of your cancer journey.