Hysterectomy
Abdominal Hysterectomy
Overview
An abdominal hysterectomy is a surgical procedure that removes your uterus through an incision in your lower abdomen. Your uterus — or womb — is where a baby grows if you’re pregnant. A partial hysterectomy removes just the uterus, leaving the cervix intact. A total hysterectomy removes the uterus and the cervix.
Sometimes a hysterectomy includes removal of one or both ovaries and fallopian tubes, a procedure called a total hysterectomy with salpingo-oophorectomy.
A hysterectomy can also be performed through an incision in the vagina (vaginal hysterectomy) or by a laparoscopic or robotic surgical approach — which uses long, thin instruments passed through small abdominal incisions.
An abdominal hysterectomy may be recommended over other types of hysterectomy if:
Sometimes a hysterectomy includes removal of one or both ovaries and fallopian tubes, a procedure called a total hysterectomy with salpingo-oophorectomy.
A hysterectomy can also be performed through an incision in the vagina (vaginal hysterectomy) or by a laparoscopic or robotic surgical approach — which uses long, thin instruments passed through small abdominal incisions.
An abdominal hysterectomy may be recommended over other types of hysterectomy if:
- You have a large uterus.
- Your doctor wants to check other pelvic organs for signs of disease.
- Your surgeon feels it's in your best interest to have an abdominal hysterectomy.
Why it's done
You may need a hysterectomy to treat:
- Gynecologic cancer. If you have a gynecologic cancer — such as cancer of the uterus or cervix — a hysterectomy may be your best treatment option. Depending on the specific cancer you have and how advanced it is, your other options might include radiation or chemotherapy.
- Fibroids. A hysterectomy is the only certain, permanent solution for fibroids — benign uterine tumors that often cause persistent bleeding, anemia, pelvic pain or bladder pressure. Nonsurgical treatments of fibroids are a possibility, depending on your discomfort level and tumor size. Many women with fibroids have minimal symptoms and require no treatment.
- Endometriosis. In endometriosis, the tissue lining the inside of your uterus (endometrium) grows outside the uterus on your ovaries, fallopian tubes, or other pelvic or abdominal organs. When medication or conservative surgery doesn't improve endometriosis, you might need a hysterectomy along with removal of your ovaries and fallopian tubes (bilateral salpingo-oophorectomy).
- Uterine prolapse. Descent of the uterus into your vagina can happen when supporting ligaments and tissues weaken. Uterine prolapse can lead to urinary incontinence, pelvic pressure or difficulty with bowel movements. A hysterectomy may be necessary to treat these conditions.
- Abnormal vaginal bleeding. If your periods are heavy, irregular or prolonged each cycle, a hysterectomy may bring relief when the bleeding can't be controlled by other methods.
- Chronic pelvic pain. Occasionally, surgery is a necessary last resort for women who experience chronic pelvic pain that clearly arises in the uterus. However, a hysterectomy provides no relief from many forms of pelvic pain, and an unnecessary hysterectomy may create new problems. Seek careful evaluation before proceeding with such major surgery.
A hysterectomy ends your ability to become pregnant. If you think you might want to become pregnant, ask your doctor about alternatives to this surgery. In the case of cancer, a hysterectomy might be the only option. But for other conditions — including fibroids, endometriosis and uterine prolapse — you may be able to try less invasive treatments first.
During hysterectomy surgery, your surgeon might also perform a related procedure that removes both of your ovaries and your fallopian tubes (bilateral salpingo-oophorectomy). You and your doctor should discuss ahead of time whether you need this procedure, which results in what’s known as surgical menopause.
With surgical menopause, menopause symptoms often begin suddenly for women after having the procedure done. Depending on how much these symptoms affect your quality of life, you may need short-term treatment with hormones.
During hysterectomy surgery, your surgeon might also perform a related procedure that removes both of your ovaries and your fallopian tubes (bilateral salpingo-oophorectomy). You and your doctor should discuss ahead of time whether you need this procedure, which results in what’s known as surgical menopause.
With surgical menopause, menopause symptoms often begin suddenly for women after having the procedure done. Depending on how much these symptoms affect your quality of life, you may need short-term treatment with hormones.
Risks
A hysterectomy is generally very safe, but with any major surgery comes the risk of complications.
Risks associated with an abdominal hysterectomy include:
Risks associated with an abdominal hysterectomy include:
- Blood clots
- Infection
- Excessive bleeding
- Adverse reaction to anesthesia
- Damage to your urinary tract, bladder, rectum or other pelvic structures during surgery, which may require further surgical repair
- Earlier onset of menopause even if the ovaries aren't removed
- Rarely, death
A hysterectomy ends your ability to become pregnant. If you think you might want to become pregnant, ask your doctor about alternatives to this surgery. In the case of cancer, a hysterectomy might be the only option. But for other conditions — including fibroids, endometriosis and uterine prolapse — you may be able to try less invasive treatments first.
During hysterectomy surgery, your surgeon might also perform a related procedure that removes both of your ovaries and your fallopian tubes (bilateral salpingo-oophorectomy). You and your doctor should discuss ahead of time whether you need this procedure, which results in what’s known as surgical menopause.
With surgical menopause, menopause symptoms often begin suddenly for women after having the procedure done. Depending on how much these symptoms affect your quality of life, you may need short-term treatment with hormones.
During hysterectomy surgery, your surgeon might also perform a related procedure that removes both of your ovaries and your fallopian tubes (bilateral salpingo-oophorectomy). You and your doctor should discuss ahead of time whether you need this procedure, which results in what’s known as surgical menopause.
With surgical menopause, menopause symptoms often begin suddenly for women after having the procedure done. Depending on how much these symptoms affect your quality of life, you may need short-term treatment with hormones.
Results
It takes time to get back to your usual self after an abdominal hysterectomy — about six weeks for most women. During that time:
- Get plenty of rest.
- Don't lift anything heavy for a full six weeks after the operation.
- Stay active after your surgery, but avoid strenuous physical activity for the first six weeks.
- Wait six weeks to resume sexual activity.
- Follow your doctor's recommendations about returning to your other normal activities.
Vaginal Hysterectomy
Overview
Vaginal hysterectomy is a surgical procedure to remove the uterus through the vagina.
During a vaginal hysterectomy, the surgeon detaches the uterus from the ovaries, fallopian tubes and upper vagina, as well as from the blood vessels and connective tissue that support it, before removing the uterus.
Vaginal hysterectomy involves a shorter time in the hospital, lower cost and faster recovery than an abdominal hysterectomy, which requires an incision in your lower abdomen. However, depending on the size and shape of your uterus or the reason for the surgery, vaginal hysterectomy might not be possible. Your doctor will talk to you about other surgical options, such as an abdominal hysterectomy.
Hysterectomy often includes removal of the cervix as well as the uterus. When the surgeon also removes one or both ovaries and fallopian tubes, it’s called a total hysterectomy with salpingo-oophorectomy. All of these organs are part of your reproductive system and are situated in your pelvis.
Vaginal hysterectomy involves a shorter time in the hospital, lower cost and faster recovery than an abdominal hysterectomy, which requires an incision in your lower abdomen. However, depending on the size and shape of your uterus or the reason for the surgery, vaginal hysterectomy might not be possible. Your doctor will talk to you about other surgical options, such as an abdominal hysterectomy.
Hysterectomy often includes removal of the cervix as well as the uterus. When the surgeon also removes one or both ovaries and fallopian tubes, it’s called a total hysterectomy with salpingo-oophorectomy. All of these organs are part of your reproductive system and are situated in your pelvis.
Why it's done
Vaginal hysterectomy treats various gynecological problems, including:
- Fibroids. Many hysterectomies are done to permanently treat these benign tumors in your uterus that can cause persistent bleeding, anemia, pelvic pain, pain during intercourse and bladder pressure. For large fibroids, you might need surgery that removes your uterus through an incision in your lower abdomen (abdominal hysterectomy).
- Endometriosis. This occurs when the tissue lining your uterus (endometrium) grows outside the uterus, involving the ovaries, fallopian tubes or other organs. Most women with endometriosis have a laparoscopic or robotic hysterectomy or abdominal hysterectomy, but sometimes a vaginal hysterectomy is possible.
- Adenomyosis. This occurs when the tissue that normally lines the uterus grows into the uterine wall. An enlarged uterus and painful, heavy periods result.
- Gynecological cancer. If you have cancer of the uterus, cervix, endometrium or ovaries, or precancerous changes, your doctor might recommend a hysterectomy. Most often, treatment for ovarian cancer involves an abdominal hysterectomy, but sometimes vaginal hysterectomy is appropriate for women with cervical or endometrial cancer.
- Uterine prolapse. When pelvic supporting tissues and ligaments weaken or stretch out, the uterus can sag into the vagina, causing urine leakage, pelvic pressure or difficulty with bowel movements. Removing the uterus and repairing supportive tissues might relieve those symptoms.
- Abnormal uterine bleeding. When medication or a less invasive surgical procedure doesn't control irregular, heavy or very long periods, hysterectomy may be needed.
- Chronic pelvic pain. If your pain is clearly caused by a uterine condition, hysterectomy might help, but only as a last resort. Chronic pelvic pain can have several causes, so an accurate diagnosis of the cause is critical before having a hysterectomy.
For most of these conditions — with the possible exception of cancer — hysterectomy is just one of several treatment options. You might not need to consider hysterectomy if medications or less invasive gynecological procedures manage your symptoms.
You cannot become pregnant after a hysterectomy. If you’re not sure that you’re ready to give up your fertility, explore other treatments.
You cannot become pregnant after a hysterectomy. If you’re not sure that you’re ready to give up your fertility, explore other treatments.
Risks
Although vaginal hysterectomy is generally safe, any surgery has risks. Risks of vaginal hysterectomy include:
- Heavy bleeding
- Blood clots in the legs or lungs
- Infection
- Damage to surrounding organs
- Adverse reaction to anesthetic
Severe endometriosis or scar tissue (pelvic adhesions) might force your surgeon to switch from vaginal hysterectomy to laparoscopic or abdominal hysterectomy during the surgery.
Results
After a hysterectomy, you’ll no longer have periods or be able to get pregnant.
If you had your ovaries removed but hadn’t reached menopause, you’ll begin menopause immediately after surgery. You might have symptoms such as vaginal dryness, hot flashes and night sweats. Your doctor can recommend medications for these symptoms. He or she might recommend hormone replacement even if you don’t have symptoms.
If your ovaries weren’t removed during surgery — and you still had periods before your surgery — your ovaries continue producing hormones and eggs until you reach natural menopause.
If you had your ovaries removed but hadn’t reached menopause, you’ll begin menopause immediately after surgery. You might have symptoms such as vaginal dryness, hot flashes and night sweats. Your doctor can recommend medications for these symptoms. He or she might recommend hormone replacement even if you don’t have symptoms.
If your ovaries weren’t removed during surgery — and you still had periods before your surgery — your ovaries continue producing hormones and eggs until you reach natural menopause.
Laparoscopic Hysterectomy
What is a laparoscopic hysterectomy?
A laparoscopic hysterectomy is a minimally invasive surgical procedure to remove the uterus. A small incision is made in the belly button and a tiny camera is inserted. The surgeon watches the image from this camera on a TV screen and performs the operative procedure. Two or three other tiny incisions are made in the lower abdomen. Specialized instruments are inserted and used for the removal process.
Some women do not have their ovaries removed when they undergo a hysterectomy. If the ovaries stay inside, the woman does not need to take any hormones after the surgery and she does not have hot flashes. Some women remove their ovaries because of family history of ovarian cancer or they have an abnormal growth on their ovary.
Women can choose to either keep the cervix in place (called a “laparoscopic supra-cervical hysterectomy”) or remove the entire uterus and cervix (“ total laparoscopic hysterectomy”).
Keeping the cervix in place makes the operation a little faster and safer. When the cervix is in place there is a 5% chance that the woman will have monthly spotting at the time of her menstrual periods. Women whose cervices stay in place need to continue getting pap smears.
If the woman wants to be 100% certain that she will never menstruate again, she needs to have the entire uterus removed. If the patient has a history of pre-cancerous changes of the cervix or uterine lining, she should have the entire uterus removed. If the operation is being done for endometriosis or pelvic pain, many doctors think the chances for pain reduction are better if the cervix is removed.
Some women do not have their ovaries removed when they undergo a hysterectomy. If the ovaries stay inside, the woman does not need to take any hormones after the surgery and she does not have hot flashes. Some women remove their ovaries because of family history of ovarian cancer or they have an abnormal growth on their ovary.
Women can choose to either keep the cervix in place (called a “laparoscopic supra-cervical hysterectomy”) or remove the entire uterus and cervix (“ total laparoscopic hysterectomy”).
Keeping the cervix in place makes the operation a little faster and safer. When the cervix is in place there is a 5% chance that the woman will have monthly spotting at the time of her menstrual periods. Women whose cervices stay in place need to continue getting pap smears.
If the woman wants to be 100% certain that she will never menstruate again, she needs to have the entire uterus removed. If the patient has a history of pre-cancerous changes of the cervix or uterine lining, she should have the entire uterus removed. If the operation is being done for endometriosis or pelvic pain, many doctors think the chances for pain reduction are better if the cervix is removed.
What are the advantages of a laparoscopic hysterectomy surgery?
A laparoscopic hysterectomy requires only a few small incisions, compared to a traditional abdominal hysterectomy which is done through a 3-6 inch incision. As a result, there is less blood loss, less scarring and less post-operative pain. A laparoscopic hysterectomy is usually done as an outpatient procedure whereas an abdominal hysterectomy usually requires a 2-3 day hospital stay. The recovery period for this laparoscopic procedure is 1-2 weeks, compared to 4-6 weeks after an abdominal hysterectomy.
The risks of blood loss and infection are lower with laparoscopic hysterectomy than with an abdominal hysterectomy. In experienced hands, laparoscopic hysterectomy takes about the same length of time as an abdominal hysterectomy and involves no greater risk.
The risks of blood loss and infection are lower with laparoscopic hysterectomy than with an abdominal hysterectomy. In experienced hands, laparoscopic hysterectomy takes about the same length of time as an abdominal hysterectomy and involves no greater risk.
Who should have laparoscopic hysterectomy surgery?
Most patients who are having a hysterectomy to treat abnormal uterine bleeding or fibroids can have a laparoscopic hysterectomy. It may not be possible in some cases. For example, if the uterus is bigger than a 4 month pregnancy, if she’s had multiple previous operations in her lower abdomen. It is usually not done for women with a gynecologic cancer.
What preparations will be needed prior to surgery?
The surgeon may have the patient see their primary care doctor prior to surgery to make sure there are no medical conditions that may cause a problem with the surgery. There will be a pre-operative appointment prior to the day of surgery which will include a history and physical examination, blood samples, and a visit w a member of the anesthesia department. Patients should not eat or drink anything after midnight on the night before surgery.
What type of anesthesia will be required?
Patients are put to sleep under general anesthesia
Is there a hospital stay after surgery?
Majority of our patients go home the same day as their surgery.
What kind of recovery can be expected?
Patients should expect to take ibuprofen or narcotic pain pills for a few days post-operatively. We encourage patients NOT to stay in bed. They should move around the house and resume normal activities as soon as they feel up to it. Some women are well enough to return to work one week after surgery. Women who have more physically demanding work should stay home for 2-3 weeks. Women can resume exercise and sex within a few weeks of the surgery.
Laparoscopic patients can expect to suffer less post-operative pain than traditional hysterectomy or cesarean section patients.
Laparoscopic patients can expect to suffer less post-operative pain than traditional hysterectomy or cesarean section patients.