Hysterectomy

   

What is a Hysterectomy?

A hysterectomy is a surgical procedure that removes the uterus through an incision in the lower abdomen (Abdominal Hysterectomy), through an incision in the Vagina (Vaginal Hysterectomy), or through the two small 

incisions in the abdomen called the laparoscopic or robotic surgical approach. Some hysterectomies also include the removal of one or both ovaries and fallopian tubes. The abdominal hysterectomy is recommended over other procedures for women who have larger uterus or if the surgeon deems that other pelvic organs need to be checked for disease. Hysterectomy is the second most common procedure in the U.S. following cesarean section. Approximately 600,000 hysterectomy procedures are performed annually in the U.S. and there are approximately 20 million women in the U.S. who have had a form of the procedure.

 

Why do Women have this Surgery?

There are various reasons for having a hysterectomy; each reason may have alternative treatments. These are the most common reasons for having a hysterectomy:  

 

  • Gynecological Cancer: Cancer such as Uterine or Cervical typically requires a hysterectomy as the best treatment option.
  • Fibroids: Hysterectomy is the only certain solution for removing benign tumors in the Uterus that can cause persistent bleeding, anemia, and pelvic and bladder pressure. Other treatment is available depending on the size of the tumor.
  • Endometriosis: occurs when the Endometrium (lining of the Uterus) grows outside of the uterus on the ovaries, fallopian tubes, or other abdominal organs. Hysterectomies are needed when medication or other surgeries fail to improve the endometriosis.
  • Uterine Prolapse: Occurs when the supporting tissues and ligaments of the uterus weaken, causing the uterus to lower into the vagina. The uterine prolapse may cause urinary incontinence and difficulty with bowel movements. A hysterectomy may be necessary to repair these conditions.
  • Persistent Vaginal Bleeding: Prolonged, irregular, or heavy periods may also be alleviated by a hysterectomy.
  • Chronic Pelvic Pain: For women who suffer from chronic pelvic pain a hysterectomy may be a last resort.

 

 

Procedures

The type of hysterectomy performed by a doctor will depend on a patient’s medical history and reason the surgery is needed. Listed below are the most common types of hysterectomy performed.

Vaginal hysterectomy: is performed through a cut in the vagina, the surgeon will take the uterus out through the incision and then close it with stitches.

Abdominal hysterectomy: is performed through a 5 to 7 inch incision--which may be vertical or horizontal--in the lower part of the abdomen, just above the pubic hair. Illustration of Abdominal Hysterectomy

Laparoscopic hysterectomy: A laparoscope is an instrument with a thin, lighted tube and small camera, which allows the physician to see your pelvic organs. The surgeon will make 3 to 4 small cuts through which the laparoscope and other instruments will be inserted. The surgeon will cut the uterus into smaller pieces and remove them through the incisions.

Laparoscopically assisted vaginal hysterectomy (LAVH): is a form of vaginal hysterectomy surgery that uses a laparoscope to guide the procedure.

Robotic-assisted surgery: a special robot may be used to do the surgery through a small cut in the lower abdomen. This surgery may be used if the patient is overweight or vaginal surgery is not safe. It is similar to Laparoscopic hysterectomy.

Recovery

The recovery period varies depending on the type of hysterectomy performed. Most women will stay in the hospital for one to two days for post-surgery care. This time may be increased if the hysterectomy was performed because of cancer. Typically it takes 4 to 6 weeks for recovery from abdominal hysterectomy surgery, with limited activity initially. Vaginal or laparoscopic surgery typically requires between 3 to 4 weeks for recovery. During these recovery periods women are encouraged to get plenty of rest and should avoid lifting heavy object for 6 full weeks. Sexual activity may resume after the 6-week mark as well.

Risks

As with any procedure there is an inherent risk of complications. Hysterectomy surgery is generally very safe, but these are the most common risks associated with the procedure:

  • Blood Clots
  • Infection
  • Adverse Reaction to Anesthesia
  • Damage to Urinary Tract, Bladder, Rectum, or Other Pelvic Structures During Surgery, which may require repair
  • Early onset menopause
  • Rarely, Death

 

References

1. LeVay, Simon, Janice I. Baldwin, and John D. Baldwin. Discovering Human Sexuality. Sunderland, MA: Sinauer Associates, 2012. Print.

 

Last Updated 28 May 2012.