At Pacific Endometriosis and Pelvic Surgery, we know our patients often want to understand the details of what happens during surgery—especially when it comes to procedures like total laparoscopic hysterectomy (TLH). One of the most common questions we hear is: “If everything is done laparoscopically, how does the uterus come out?”

The answer surprises many people—the uterus is usually removed through the vagina, not through the abdominal incisions. During a TLH, small incisions on the abdomen are used to insert a camera and surgical instruments. The surgeon carefully frees the uterus and cervix from their supporting tissues and blood supply, separating them from the top of the vagina. Once fully detached, the uterus and cervix are delivered vaginally. This allows the specimen to be removed intact, avoiding the need to enlarge any abdominal incisions and reducing recovery time.

After the uterus is removed, the top of the vagina—where the cervix used to be—is sutured closed. This area is called the vaginal cuff.  During healing, it’s important to avoid heavy lifting or placing anything in the vagina to give the cuff time to heal completely. We typically see patients back around six weeks after surgery to check that the vaginal cuff incision has healed well and everything looks as expected.

To help you visualize this part of the procedure, we’ve created a short video demonstrating the separation of the uterus and cervix, removal of the uterus through the vagina, and closure of the vaginal cuff.

🎥 Watch: Anatomy & Endo — Removal of the Uterus during TLH

At Pacific Endometriosis and Pelvic Surgery, it’s important to us that our patients understand what’s being done and why. Surgery can feel mysterious, but we believe education helps replace uncertainty with confidence. We encourage all our patients to ask questions at any point in the process—before, during, and after surgery—because your understanding is a key part of your care.