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Hysterectomy

Definition

A hysterectomy is surgery to remove a woman’s uterus. It may be done through an incision (cut) in either the abdomen (belly) or the vagina.

Alternative Names

Vaginal hysterectomy; Abdominal hysterectomy; Supracervical hysterectomy; Radical hysterectomy; Removal of the uterus; Laparoscopic hysterectomy; Laparoscopically assisted vaginal hysterectomy; LAVH; Total laparoscopic hysterectomy; TLH; Laparoscopic supracervical hysterectomy; Robotically assisted hysterectomy

Description

Your doctor will help you decide which type of hysterectomy is best for you. It will depend on your medical history and the reason for your surgery.

• Abdominal hysterectomy: The surgeon makes a 5-inch to 7-inch incision (cut) in the lower part of your belly. The cut may go either up and down, or it may go across your belly, just above your pubic hair (a bikini cut).
• Vaginal hysterectomy: The surgeon makes a cut in your vagina. Your uterus will be taken out through this cut. The cut in your vagina will be closed with stitches.
• Laparoscopic hysterectomy: A laparoscope is a narrow tube with a tiny camera on the end. Your surgeon will make 3 to 4 small cuts in your belly. The laparoscope and other surgical instruments will be inserted through the other cuts. Your uterus will be cut into smaller pieces that your surgeon will remove through the small cuts.
• Laparoscopically assisted vaginal hysterectomy: Your surgeon will remove your uterus through a cut inside your vagina. Your surgeon will also insert a laparoscope and other instruments into your belly through 2 or 3 small cuts.
• Robotic surgery is like laparoscopic surgery, but a special machine is used. It is most often used when a patient has cancer or is very overweight and vaginal surgery is not safe. See also: Robotic surgery

During a hysterectomy, the whole uterus or just part of it may be removed. The fallopian tubes (the tubes that connect the ovaries to the uterus) and ovaries may also be removed.

• A partial (or supracervical) hysterectomy is removal of just the upper part of the uterus. The cervix is left in place.
• A total hysterectomy is removal of the entire uterus and the cervix.
• A radical hysterectomy is the removal of the uterus, the tissue on both sides of the cervix (parametrium), and the upper part of the vagina. This is done mostly when some cancers are present.

Why the Procedure Is Performed

There are many reasons a woman may need a hysterectomy. But, there may be ways to treat your condition that do not require this major surgery. Your condition may be helped with less invasive surgery. Talk with your doctor about your treatment options.

After having their uterus removed, many women will notice changes both in their body and in how they feel about themselves. Talk with your doctor, your family, and your friends about these possible changes before you have surgery.

Hysterectomy may be recommended for:

• Tumors in the uterus, like uterine fibroids
• Cancer of the uterus, most often endometrial cancer
• Cancer of the cervix or a precancerous condition of the cervix called cervical dysplasia
• Cancer of the ovary
• Endometriosis, when your pain is severe and other treatments have not helped
• Severe, long-term (chronic) vaginal bleeding that cannot be controlled by medicines
• Prolapse of the uterus. A prolapsed uterus slips down into the vagina.
• Adenomyosis. This condition causes the tissue that lines the uterus to grow inside the walls of the uterus.
• Chronic pelvic pain
• Complications during childbirth, like bleeding that cannot be controlled

See also:

• Fibroid tumor treatment
• Uterine artery embolization

Risks

The risks for any surgery are:

• Allergic reactions to medicines
• Breathing problems
• Blood clots in your leg or pelvic veins that may travel to your lungs. These can be fatal.
• Bleeding
• Infection

Risks that are possible from a hysterectomy are:

• Injury to nearby organs, including the bladder or blood vessels
• Injury to bowels
• Pain during sexual intercourse
• Early menopause, if the ovaries are removed also

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

During the days before the surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs like these.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your doctor or nurse for help quitting.

On the day of your surgery:

• You will usually be asked not to drink or eat anything for 8 hours before the surgery.
• Take your drugs your doctor told you to take with a small sip of water.

Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

The average hospital stay depends on the type of hysterectomy you had. Most women stay 2 to 3 days. When hysterectomy is done because of cancer, the hospital stay is often longer.

You will be given pain medicine after surgery through an IV (intravenous, through a vein) and pills. You may also have a catheter into your bladder for 1 to 2 days to pass urine. You will be asked to get up and move around as soon as possible. This will help keep blood clots from forming in your legs and will help you avoid other problems as you recover.

You will be asked to get up to use the bathroom as soon as you are able. You may return to a normal diet as soon as your bowels start working again.

Outlook (Prognosis)

Complete recovery may take 2 weeks to 2 months. Recovery from a vaginal or laparoscopic hysterectomy is faster than recovery from an abdominal hysterectomy. It may also be less painful. Average recovery times are:

• Abdominal hysterectomy -- 4-6 weeks.
• Vaginal hysterectomy -- 3-4 weeks.

If your ovaries are also removed and you have not gone through menopause yet, this surgery will cause menopause. Your doctor may recommend estrogen replacement therapy.

Some women worry that their sexual function will decrease after their uterus is removed. Sexual function after a hysterectomy depends mostly on what sexual function was like before the surgery.

References

Katsumori T, Kasahara T. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial). Am J Obstet Gynecol. 2006;195:1190.

Entman SS, Graves CR, Jarnagin BK, Rao GG. Gynecologic surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 75.

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