Hysterectomy

Quick look at hysterectomy

Hysterectomy is a surgery that removes a woman’s uterus. Surgeons perform vaginal, abdominal or laparoscopic forms of hysterectomy.

The surgery’s benefits are as a lasting treatment for several gynecological conditions. Oftentimes patients have been treated with less invasive methods first but ultimately may need a hysterectomy.

Risks of hysterectomy include those for any surgery, such as blood loss, infection or tissue damage. Additionally, women will no longer have a uterus and therefore will not have periods or be able to become pregnant. If the ovaries are removed as part of the hysterectomy she will enter into menopause.

What is a hysterectomy & who may need one?

A hysterectomy is the surgical removal of a woman’s uterus, which may be done to treat a variety of conditions related to a woman’s reproductive system. During this procedure the entire uterus is removed. The ovaries and fallopian tubes may also be removed depending on the condition that the hysterectomy is treating. A hysterectomy is the second most common surgical procedure for women in the United States, after a cesarean (C-section) delivery.

Hysterectomy is an option for women who have tried to treat their gynecological condition with conservative methods but are still symptomatic. In such cases their OB-GYN may recommend surgical treatment. Because it is a major surgery, OB-GYNs generally consider a hysterectomy as the final option.

Hysterectomy treats the following common conditions:

• Uterine fibroids
• Heavy, painful periods
• Abnormal vaginal bleeding
• Endometriosis
• Uterine prolapse
• Cancer of the uterus, ovaries, cervix, endometrium or fallopian tubes.

Types of hysterectomies

Women should work with their OB-GYN to discuss their medical condition and the best treatment options. Hysterectomies vary in the extent of removal of the reproductive organ(s) during the procedure.

• Total hysterectomy: Removes the entire uterus including the cervix. The fallopian tubes and ovaries may or may not be removed. This is the most common type of hysterectomy.
• Partial hysterectomy: Removes only the upper part of the uterus, leaving the cervix in place. The fallopian tubes and ovaries may or may not be removed.
• Radical hysterectomy: Removes all of the uterus, cervix and the upper part of the vagina. The fallopian tubes and ovaries may or may not be removed. A radical hysterectomy is typically used for treating cervical or other types of cancer in this area.

How is a hysterectomy performed?

Surgeons can perform a hysterectomy in different ways depending on the reason for the procedure and the specifics of the patient’s condition. Women should discuss the options, as well as recovery time, with their doctor before their surgery.

Abdominal hysterectomy

A hysterectomy can be performed through an abdominal incision, which can be vertical or horizontal. A horizontal incision would normally be located right above the pubic bone. The incision is usually between 4 to 16 inches long and gives the surgeon access to the woman’s reproductive organs.

Vaginal hysterectomy

A vaginal hysterectomy is removal of the uterus through a small incision at the top of the vagina. This type of minimally invasive surgery involves removing the uterus through the vagina, thereby avoiding an abdominal incision.

Laparoscopic hysterectomy

Laparoscopic hysterectomy is a form of minimally invasive surgery for removal of the uterus that starts with a few small, half-inch incisions on the abdomen. A laparoscope, which is a thin instrument with a light and camera, is then inserted through these incisions. The doctor will use special operating instruments to remove the uterus through these small incisions or through the vagina.

Robotic hysterectomy

Performing a robotic hysterectomy is done similarly to a laparoscopic hysterectomy. It utilizes a computer-assisted robotic device the surgeon directs to perform more intricate procedures in smaller spaces than could be accomplished by hand alone.

Recovery time

The recovery time for a hysterectomy depends on the type of procedure and how it was done. Many women who undergo a vaginal or laparoscopic hysterectomy are able to go home the same day as their surgery. Most women stay in the hospital for one to two days after an abdominal hysterectomy.

Some pain the first few days after surgery is normal and total recovery can take a few weeks. Bleeding and discharge from the vagina for a few weeks after the procedure is normal.

What are the considerations & risks of hysterectomy?

All women who have their uterus removed through a hysterectomy will stop having periods and will not be able to get pregnant. If a woman’s ovaries were removed during the procedure she will enter menopause right away.

As with other surgeries, hysterectomies carry some risks. Women and their OB-GYN should discuss these risks beforehand. Some women are more prone to risks than others. Abdominal hysterectomies more commonly result in risks than other forms. These risks include:

• Blood loss
• Infection
• Injury to tissues and organs close to the urinary tract
• Reactions to anesthesia
• Blood clots
• Scarring
• Pain.