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The procedure to surgically remove the uterus is called a hysterectomy. There are many medical reasons that will cause a doctor to suggest hysterectomy. A woman can think over all the pros and cons of uterus removal before opting for this procedure; as this procedure is rarely performed in an emergency.

Why is Hysterectomy Required?

Hysterectomy is considered as a major surgery. It involves complete removal, that is, removal of the uterus, fundus as well as cervix or partial, that involves, removal of the uterus without removing the cervix. After a lot of consideration, a doctor will suggest hysterectomy. This is because removal of the uterus affects the health of a woman as well as the hormonal balance of the body. Also, the woman loses her child bearing ability. Thus, it is mostly advised to woman who have borne children or have passed their menopause. In case of a young woman who does not wish to remove her uterus, other methods are sought. Situations where hysterectomy is unavoidable are as follows:

  • Pain, bleeding and other problems caused due to the presence of uterine fibroids.
  • In cases where the endometrium (uterine lining) starts growing on organs other than the uterus, that is, endometriosis.
  • In case of placenta that grows over or inside the birth canal (placenta praevia) or grows on other organs (placenta percreta).
  • In case of different types of vaginal prolapsed.
  • When the uterus slips into the vaginal cavity, that is, uterine prolapsed.
  • Uterine, cervical or ovarian cancer
  • When the uterine wall thickens abnormally, that is, adenomyosis.
  • Chronic pelvic pain that does not subside with the traditional treatment methods.
  • In case of gender change operations.

What are the Types of Hysterectomy?

There are different types of hysterectomy that are carried out on the basis of the condition of the patient. These types of hysterectomies include:

  • Radical Hysterectomy: This involves complete removal of the uterus, cervix, upper vagina as well as the tissues on the side of the uterus. This surgery is suggested in case of cancer.
  • Supracervial Hysterectomy: Also called as subtotal hysterectomy, it involves removal of just the uterus body. The cervix and other organs are kept in place.
  • Total Hysterectomy: The most common surgery performed is total hysterectomy. It involves removal of the uterus along with the cervix.

Preparation Before the Surgery

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Before the surgery, the doctor will advise a few tests in order to decide which type of surgery will be best to perform. These tests are as follows:

  • Examination of the pelvic region
  • Complete Blood Count
  • Pap Smear
  • Pelvic Ultrasound

Once the surgery is decided, the patient will be given dates for surgery. Then the patient is hospitalized and her blood and urine samples are taken for examination. If need be, enemas are given to clear the digestive track. The abdomen and pelvic area is shaved clean for a better view during the surgery.

How is Hysterectomy Performed?

Hysterectomy is performed under general anesthesia. There are different surgical methods that the surgeon may choose to perform. Let us have a look at these methods that the surgeon may choose to approach.

Open Hysterectomy: The traditional method of operation is open or abdominal hysterectomy. This surgery is performed in over 65% of all cases. In this method:

  • The patient is given general anesthesia.
  • A transverse incision is made in the abdominal wall. This incision is about 5 to 7 inches in length.
  • The incision is made either side-to-side or up-and-down. It is made just above the pubic bone.
  • This method is commonly approached as it helps give the surgeon a clear view of the abdominal cavity.
  • The recovery time for abdominal hysterectomy is about 4-6 weeks.
  • This surgery leaves a scar on the abdomen.

Vaginal Hysterectomy: This method is used to perform a subtotal hysterectomy.

  • The surgeon reaches the uterus through the vagina.
  • A cut is made in the vagina and the uterus is removed through this cut.
  • This cut is then stitched and requires a short period of healing time.
  • After healing, no visible scar remains.

Other than these surgical methods, there are minimally invasive procedures that can be opted for. These procedures include:

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Laparoscopic-assisted vaginal Hysterectomy: This surgery is carried out using a laparoscope.

  • This is a long tube with a camera on one end and the other end attached to a monitor outside.
  • It is also attached to surgical tools that help in making cuts in the abdomen.
  • With the help of the view on the monitor, the surgeon removes the uterus and cervix, with or without removing the other organs like ovaries through the vagina.

Laparoscopic-assisted supracervical hysterectomy: This method is carried out using laparoscopic method. The uterus is cut into small pieces and removed from the abdominal cavity.

Subtotal Laparoscopic Hysterectomy: This surgery is carried out just as laparoscopic-assisted vaginal hysterectomy. However, only the uterus is removed without removing the cervix and fundus.

Robotic Hysterectomy: A new surgery in the field of hysterectomy is robot assisted hysterectomy. Here, the surgeon uses a sophisticated robotic machine to carry out the surgery. The surgeon takes a look within the body on a three-dimensional screen.

After Surgery Care

After the surgery is successful, the patient may feel pain and discomfort for the first few days. However, the pain is managed with the help of painkillers. The patient can start walking on the second or maximum third day of the surgery. After a few days, depending on the patients' health, she is discharged.

Complications Related to Hysterectomy

A hysterectomy does not lead to any serious complications in majority of the cases. Complications, if any include:

  • Vaginal prolapsed
  • Chronic pain
  • Urinary incontinence
  • Hormonal imbalance
  • Infection or injury to nearby organs like the bladder, rectum, etc.
  • Painful sex
  • Blood clot in the lungs or legs
  • Heavy bleeding after the surgery

Alternatives to Hysterectomy

There are different alternatives to hysterectomy. Newer methods are developed of which the following are a few:

  • Levonorgestrel intrauterine device: This device helps in controlling uterine bleeding.
  • Endometrial ablation: The procedure uses heat to destroy the lining of the uterus. This helps in reducing the bleeding.
  • Uterine artery embolization (UAE): A minimally invasive procedure that is required for treating uterine fibroids.
  • Magnetic Resonance guided Focused Ultrasound (MRgFUS): A latest non-invasive procedure in the field of surgery is MRgFUS. Here, high frequency magnetic resonance is used to destroy the fibroid tissues.

Women who undergo hysterectomy with the removal of ovaries along with the uterus, require hormone replacement therapy, especially if they have not yet passed menopause. Speak to your doctor in detail about this surgery. Ask and clear all doubts in your mind. Hysterectomy leads to ‘surgical menopause’ and the woman loses her ability to bear children. Think and go through all the pros and cons and decide whether you are up for this low-risk surgery.

Written by: Saptakee sengupta
Date last updated: February 4, 2015

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