Hysterectomy

A hysterectomy is a surgical procedure to remove the uterus. Healthcare providers may suggest a hysterectomy to treat a variety of conditions related to the uterus.

Some uterine conditions where a hysterectomy may be considered are:

Uterine cancer
Endometriosis
Uterine prolapse
Abnormal uterine bleeding
Chronic pelvic pain
Adenomyosis

TYPES OF HYSTERECTOMY

There are different types of hysterectomy:

Total Hysterectomy: A total hysterectomy procedure is the surgical removal of the entire uterus including the cervix. This procedure can be performed as a robot-assisted laparoscopic, vaginal, traditional laparoscopic or abdominal surgery.
Supracervical or Partial Hysterectomy: With this type of hysterectomy the upper part of the uterus is removed but the cervix is left in place. This type of surgery can only be performed laparoscopically or abdominally.
Radical Hysterectomy: This is a total hysterectomy that also includes removal of structures around the uterus. This type of hysterectomy is recommended if cancer is suspected or has been diagnosed.

The Rosemark gynecologists are expert board-certified physicians and surgeons. Through careful evaluation, the necessity and type of hysterectomy to best suit the needs of each patient will be reviewed and discussed on an individual basis.

OVARIES AND FALLOPIAN TUBES

When a total hysterectomy is performed, the need to remove the ovaries and fallopian tubes will be in question. Prior to the surgery, the surgeon may not know whether the ovaries and/or fallopian tubes will need to be removed. One or both of the ovaries and fallopian tubes may need to be removed if they are abnormal or if the uterus is cancerous.

These surgical procedures which typically take place in tandem with a hysterectomy and include:

Salpingo-oophorectomy: This is the procedure where both of the fallopian tubes and ovaries are removed.
Salpingectomy: This is the procedure where only the fallopian tubes are removed.
Oophorectomy: This is the procedure where only the ovaries are removed.

Patients who are at risk of ovarian or breast cancer may opt to have both ovaries and fallopian tubes removed to reduce the risk of cancer. This procedure is considered an elective salpingo-oophorectomy.

SURGICAL MENOPAUSE

When the ovaries are removed before a patient has gone through menopause, they will likely experience menopause symptoms such as night sweats, hot flashes and mood changes. This condition is called surgical menopause. The Rosemark gynecologists may choose to treat this condition with hormone medication to relieve these symptoms. Hormone therapy can be started immediately after surgery.

HYSTERECTOMY METHODS

Vaginal Hysterectomy

A vaginal hysterectomy is a surgical procedure to remove the uterus through the vagina thus avoiding an abdominal incision. Not all women are well suited for a vaginal hysterectomy. Women who may not receive a hysterectomy vaginally include women who have/ had:

Multiple C- sections
Major abdominal surgery
Past pelvic infections
Endometriosis
Problems with obesity
Small pelvic bony canal
A uterus too large to be removed vaginally

The typical benefits of having a vaginal hysterectomy are the lower risk of complications and shorter healing time. A vaginal hysterectomy is recommended as the first choice when possible.

Abdominal Hysterectomy

An abdominal hysterectomy is a surgical procedure performed by removing the uterus through an incision in the lower abdomen. Abdominal hysterectomies can be performed even if adhesions are present or if the uterus is very large.

An abdominal hysterectomy is associated with greater risk of complications, such as blood clots, wound infection, bleeding, nerve and tissue damage, than a vaginal or laparoscopic hysterectomy. It generally requires a longer hospital stay, typically one to two nights.

The recovery time is also considerably longer taking between four to six weeks for full recovery. During the recovery time, heavy lifting must be avoided (no more than 10 pounds). Driving should be avoided for one to two weeks and no sexual intercourse for six weeks.

Laparoscopic Hysterectomy

A laparoscopic hysterectomy involves removing the uterus with a laparoscope. A laparoscope is a narrow telescope-like instrument that makes the inside of the abdomen visible for the surgeon.

During a laparoscopic hysterectomy, the patient is placed under general anesthesia. The abdomen is then inflated with carbon dioxide gas to create space for operating. Then, four to five small incisions are made in the navel and lower abdomen where the laparoscope and other narrow surgical instruments are inserted. After the uterus has been detached it may be removed through the vagina.

Laparoscopic hysterectomies are far less invasive than abdominal surgeries. Compared with abdominal hysterectomy, laparoscopic surgery results in less pain, has a lower risk of infection, and requires a shorter hospital stay. Patients are likely to be able to return to normal activities sooner. The hospital stay is usually overnight and recovery time is approximately 2-3 weeks.

There also are risks with laparoscopic surgery. It can take longer to perform compared with abdominal or vaginal surgery. There is also an increased risk of injury to the urinary tract and other organs with this type of surgery.

Cutting-Edge Surgical Technology

A robot-assisted laparoscopic hysterectomy is performed with the help of a robotic machine controlled by the surgeon. Robot-assisted laparoscopic hysterectomy is the removal of the uterus using the DaVinci® Surgical System (robot) to perform a laparoscopic hysterectomy.

As with traditional laparoscopic hysterectomy, four to five small incisions are made and instruments are placed in the lower abdomen through the incisions. The robotic system translates the surgeon’s hand movements outside the woman’s body into precise surgical movements inside the abdomen. They key benefits of the robotic system are:

3D HD view inside your body
Wristed instruments that bend and rotate far greater than the human hand
Enhanced vision, precision and control

The Rosemark gynecologic surgeons are specially trained with the Da Vinci® Surgical System to take full advantage of the greater precision and the most minimally invasive surgical method available today.

AFTER CARE

A hysterectomy is one of the safest surgical procedures. As with any surgery, however, there risks such as:

Infection, fever, heavy bleeding
Injury to the urinary tract, intestines or other nearby organs
Problems related to anesthesia
Risk of pulmonary embolism

Patients may need to stay in the hospital for a few days after surgery. The length of hospital stay will depend on the type of hysterectomy, the method of surgery, and how the body reacts to the surgery.

Patients can expect to have some pain for the first few days after the surgery and will be given medication to relieve pain. Vaginal bleeding and discharge is common for several weeks along with constipation and difficulty urinating. To avoid constipation, patient will be encouraged to drink plenty of water and to take a stool softener.

Patients will be urged to get plenty of rest but to also walk around as soon as possible after surgery. Walking will help prevent blood clots in the legs so they should begin with short walks and then gradually increase over time. Patients may also receive medicine or other care to help prevent blood clots.

It is common for women to have an emotional response to hysterectomy. They may feel depressed that they are no longer able to bear children but they may also be relieved that difficult symptoms are gone.

Patients are encouraged to express their feelings to their support system including their Rosemark provider to help work through their emotional difficulties.

Rosemark patients should follow their gynecologist’s specific instructions including:

Getting plenty of rest
Moving around as often as possible
Start taking short walks and gradually increase the distance
Refrain from lifting heavy objects until your doctor says you can (no more than 10 pounds)
Refrain from putting anything in the vagina during the first 6 weeks (no douching, tampons or sex)

Finally, patients should continue to see their Rosemark health care provider for routine gynecologic exams and general health care.

CONCLUSION

If you are concerned about the necessity of a hysterectomy, please call Rosemark for an appointment. One of our board-certified gynecologists will get to know you and your situation and will be able to make a recommendation that is right for you.