Hysterectomy is an operation to remove a woman’s uterus. Some of the reasons why a woman would want to undergo hysterectomy include:
- Cancer of the uterus, cervix, or ovaries
- Uterine prolapse (sliding of the uterus from its original position into the vaginal canal)
- Uterine fibroids
- Adenomvosis (thickening of the uterus)
- Abnormal vaginal bleeding
- Chronic pelvic pain
Hysterectomy for noncancerous reasons is usually considered only after all other treatment options have failed.
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Types of Hysterectomy
Depending on the reason for the hysterectomy, a surgeon may choose to remove all or only part of the uterus. It is vital to clarify if the cervix and/or ovaries are removed.
- In a supracervial or subtotal hysterectomy, a surgeon removes only the upper part of the uterus, keeping the cervix in place.
- Total hysterectomy removes the whole uterus and cervix.
- Radical hysterectomy removes the whole uterus, tissue on the sides of the uterus, the cervix, and the top part of the vagina. Radical hysterectomy is only performed when cancer is present.
- Oophorectomy removes the ovaries
- Salpingectomy removes the tubes
So, when the entire uterus, both tubes, and both ovaries are removed, the entire procedure is called a hysterectomy and bilateral salpingectomy-oophorectomy.
Surgical Techniques for Hysterectomy
Surgeons use different methods for hysterectomy, depending on the reason for the hysterectomy, and a woman’s overall health. The hysterectomy procedure will partly determine healing time and the kind of scar, if any, that remains after the operation.
There are two methodologies to surgery – a traditional or open surgery and a minimally invasive procedure or MIP.
Open Surgery Hysterectomy
This is the most common method to hysterectomy, accounting for about 65% of all procedures. An abdominal hysterectomy is called an open surgery.
To perform an abdominal hysterectomy, a surgeon makes a 5- to 7-inch incision, either up-and-down or side-to-side, across the belly. The surgeon then removes the uterus through this opening.
A woman will usually spend 2-3 days in the hospital after an abdominal hysterectomy. There is also a visible scar at the location of the incision after healing.
There are several methods that can be used for an MIP hysterectomy:
- Vaginal hysterectomy: The surgeon makes an incision in the vagina and removes the uterus through this opening. The cut is closed, leaving no visible scar.
- Laparoscopic hysterectomy: This approach involves using a laparoscope, which is a tube with a lighted camera, and surgical tools inserted through several small cuts made in the belly or, in the case of a single site laparoscopic procedure, one small cut created in the belly button. The surgeon performs the hysterectomy from outside the body, viewing the operation on a video screen.
- Laparoscopic-assisted vaginal hysterectomy: Using laparoscopic surgical tools, a surgeon removes the uterus through an opening in the vagina.
- Robot-assisted laparoscopic hysterectomy: The surgeon controls a robotic system of surgical tools from outside the body. Advanced technology allows the surgeon to use natural wrist movements and view the hysterectomy on a three-dimensional screen.
Comparing MIP Hysterectomy to Abdominal Hysterectomy
The MIP approach offers a number of benefits when compared to the open surgery used for an abdominal hysterectomy. An MIP allows for faster recovery, less pain and scarring, and a lower chance of infection than does an abdominal hysterectomy.
Women are generally able to resume their normal activity within an average of three to four weeks, compared to four to six weeks for an abdominal hysterectomy.
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The costs associated with an MIP are significantly lower than the costs associated with open surgery, depending on the instruments used and the time spent in the operating room. Robotic procedures, however, can be much more expensive. There is also less risk of incisional hernias with an MIP.
Some woman may not be fit for the MIP. The presence of scar tissue from previous surgeries, obesity, and health status can all affect whether or not an MIP is advisable. You should talk with your doctor on the best approach for you.
Most surgeries are without complications, and hysterectomy is not an exception. Most women who undergo hysterectomy have no serious problems. However complications may include:
- Urinary incontinence
- Chronic pain
- Vaginal prolapse (part of the vagina coming out of the body)
- Fistula formation (an abnormal connection that forms between the vagina and bladder)
Other risks from hysterectomy include blood clots, wound infections, hemorrhage, and injury to surrounding organs, although these are rare.
What to Expect After Hysterectomy
After a hysterectomy, if the ovaries were also removed, a woman will enter menopause. If the ovaries were not removed, a woman may enter menopause at an earlier age. Most women are told to abstain from sex and avoid lifting heavy objects for six weeks after hysterectomy.