HYSTERECTOMY

Hysterectomy

A hysterectomy means to remove the uterus. This surgery is one of the most common woman’s surgical procedures in the United States. Once the uterus has been removed the patient is unable to become pregnant.

Indications for Hysterectomy

There are many reasons why a woman might be offered a hysterectomy and they include:

Painful periods
Abnormal uterine bleeding (heavy and difficult to control periods)
Fibroids or tumors of the uterus (non-cancerous)
Uterine prolapse – pelvic support problem
Chronic pelvic pain
Uterine/Cervix/Ovarian Cancer

Alternatives to Hysterectomy

A woman should explore her options (if she chooses to do so) prior to getting a hysterectomy. Sometimes medications, devices and less invasive surgical procedures are options. Please realize that not all gynecologists understand or know all the options. Also, many gynecologists are not trained to offer or perform other surgical options. A second and third opinion is encouraged for all patients.

Examples of alternatives include:

Abnormal uterine bleeding – can sometimes be treated with birth control pills or hormonal manipulation; another alternative might include endometrial ablation
Uterine prolapse – does not always require surgery alternative include: pessary therapy or a less invasive alternative of supporting the uterus known as a hysteropexy.
Chronic pelvic pain – unless the patient has central chronic pelvic pain a hysterectomy is not always required to treat the pain more often than not the uterus is not the reason for most women’s pelvic pain

Types of Hysterectomies

Total hysterectomy- means the whole uterus including the cervix is removed this does not mean the ovaries are removed
Supracervical hysterectomy – (aka subtotal or partial hysterectomy) is the removal of the body of the uterus but leaving the cervix behind
Radical hysterectomy – is performed primarily for cancer patients and this removes the uterus and surrounding structures such as fallopian tubes and ovaries

Hysterectomy Techniques

TVH –transvaginal hysterectomy- this approach is directly through the vagina without any abdominal incisions.
TAH- total abdominal hysterectomy- approaches the removal of the uterus through a large abdominal incision known as a laparotomy.
LAVH- laparoscopic assisted vaginal hysterectomy – approaches the hysterectomy through miniature incisions on the abdomen known as laparoscopy and then the removal of the uterus through the vaginal opening.
TLH – total laparoscopic hysterectomy – is a laparoscopic approach to removal of the uterus just using the laparoscopic.
Robotic hysterectomy – is a version of laparoscopy but using a robot to remove the uterus through slightly larger incisions than laparoscopy.

Complications

There are more than a half million hysterectomies performed in the US every year. There is the potential for many different types of complications and the incidence of complications does vary with the technique utilized, the surgeon’s ability, the indication for the hysterectomy, the number of previous surgeries and associated pathology as well as the size and weight of the patient.

The most common complications are categorized as: infectious, venous thromboembolism (blood clots), injury to genitourinary (GU) or gastrointestinal (GI) tract, hemorrhage (bleeding), nerve injury and vaginal cuff breakdown.

Summary

Hysterectomy is one of the most common surgical procedures performed on women in the US every year. This procedure is not without complications and the surgeon who is recommending the surgery will have his or her own preference as to the technique utilized to remove the uterus. Be sure to consider less invasive techniques to treat your underlying condition but if you proceed with a hysterectomy be informed as to the approach and your surgeons skill level and rate of complications.

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