What is Hysterectomy?
- Hysterectomy is the surgical removal of the uterus, or womb.
- Depending upon the type of procedure that is performed and the reason for the surgery, hysterectomy may also include removal of the adjacent Fallopian tubes and ovaries.
- Hysterectomy is the most common major surgical procedure (unrelated to pregnancy) performed on women in the US. Because of the advancing development of less invasive treatment options, the incidence of hysterectomy has declined in recent years.
- Hysterectomy is a treatment option in the treatment of uterine cancer and cervical cancer as well as for some benign conditions that cause pain and/or severe vaginal bleeding.
- Fibroid tumors, severe endometriosis, adenomyosis, uterine prolapse, and uncontrollable vaginal bleeding are some benign conditions that are frequently treated with hysterectomy.
- Different types of surgical techniques are available for the performance of a hysterectomy. The choice of which method to use is dependant upon the reason for the procedure and the underlying medical condition of the patient.
- Traditional surgical approaches include both abdominal and vaginal hysterectomies, as well as newer, laparoscopic and robotic surgical methods, which significantly reduce operative times and diminish post-operative pain.
Prior to considering a hysterectomy, your doctor should review both the attendant risks and benefits if the procedure, and discuss any appropriate alternative treatment options. A thorough physical examination, including blood tests, is necessary prior to surgery. In some cases, imaging studies (such as ultrasound, CT, or MRI scans) will be carried out prior to the procedure. If appropriate, an endometrial biopsy (sampling of tissue inside the uterus) may be done to rule out cancer or a precancerous condition of the uterine lining is present.
Depending upon the type of procedure chosen and the type of anesthesia, further preparations may include fasting prior to the operation.
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All hysterectomies are performed under regional or general anesthesia in a hospital operating room.
A number of different procedures for hysterectomy are used. Some require standard surgical incisions while others are performed primarily via laparoscopy with small abdominal incisions for insertion of the laparoscope and other surgical instruments.
- Total abdominal hysterectomy (TAH) is the removal of the uterus and cervix through an abdominal incision that is 6-8 inches in length.
- Supracervical or subtotal hysterectomy is removal of the uterus while sparing the cervix (the opening of the uterus into the vaginal or birth canal). This can be done laparoscopically or via standard surgical incisions.
- Radical hysterectomy is used in the treatment of cancer and includes removal of some surrounding tissues. This is most commonly performed via an abdominal incision, but it or can be done with laparoscopic or robot-assisted laparoscopy techniques.
- Vaginal hysterectomy is removal of the uterus and the cervix through the vagina. This procedure involves an incision in the upper vagina. in many cases, the tubes and ovaries can also be removed vaginally.
- Laparoscopic hysterectomy (LH) involves removal of the uterus by laparoscopic (minimally invasive) techniques. This procedure requires several tiny incisions below the area of the navel for insertion of the viewing laparoscope and the surgical instruments. In order for the surgeon to observe the inside of the body clearly, the abdominal cavity is inflated with a gas (usually carbon dioxide). The uterus is then either extracted vaginally or through the small abdominal incisions by division into smaller pieces.
- Laparoscopy-assisted vaginal hysterectomy (LAVH) is vaginal hysterectomy with the assistance of laparoscopic techniques as described above.
- Oophorectomy is the surgical removal of the ovary(s); salpingo-oophorectomy refers to is the removal of the ovary(s) and the Fallopian tube(s). These procedures may be performed at the same time as hysterectomy if indicated.
Women are encouraged to get up and walk within a day of the operation (within hours after a laparoscopic procedure) to reduce the possibility of developing blood clots in the legs and to speed overall healing. Analgesics are given to control pain at the incision sites. Some women experience nausea following the procedure, particularly after a general anesthetic. Full recovery from a total abdominal hysterectomy can take 4 to 6 weeks. Recovery times are shorter for a vaginal or laparoscopic hysterectomy. Sexual intercourse can resume 4 to 6 weeks after the procedure.
Hysterectomy Risks and Complications
Complications of hysterectomy, as with any major surgical procedure, include bleeding and infection along with any risks related to the drugs used in anesthesia. Other possible complications specific to hysterectomy include injury to the bowel, bladder, or ureter; nerve damage; and urinary tract infection; or even death.
If a premenopausal woman undergoes hysterectomy with concurrent removal of the ovaries (oophorectomy), menopausal symptoms will typically begin within a few days. These symptoms can include hot flashes, vaginal dryness, discomfort during sexual intercourse, and mood disturbances. If appropriate, these symptoms can be managed with hormone therapy (HT).
Your doctor will schedule a follow-up appointment for several weeks following the procedure. The frequency of other follow-up visits will depend largely on the progress of the patient.
Hysterectomy is a common and generally very safe procedure. Most women recover fully with no complications. It is a very effective treatment for fibroid tumors, adenomyosis, and abnormal vaginal bleeding when less aggressive treatment options have not been successful. The outlook for hysterectomy when used as part of treatment for cervical or uterine cancer depends upon the exact type and stage (extent of spread) of cancer and varies according to the individual case.