Hysterectomy is a surgical procedure to remove all or part of the uterus, unrelated to whether the ovaries are removed or retained. The uterus is made up of two parts, the cervix or part protruding into the vagina and the fundus or major muscular part contained within the pelvis. A complete hysterectomy means removal of all of the uterus while a partial or subtotal hysterectomy means removal of only the fundus, leaving the cervix in place. The ovaries may or may not be removed with hysterectomy.
Hysterectomy may be performed to treat certain conditions that affect the uterus, including, uterine fibroids, endometriosis, refractory uterine bleeding, chronic pelvic pain, pelvic support problems or prolapse, and cancer. The approach or type of hysterectomy depends on the condition being treated as well as findings of a pelvic exam. Abdominal, vaginal, laparoscopic assisted vaginal or total laparoscopic hysterectomy with or without the use of a robot may be suggested.
Abdominal hysterectomy is performed through an incision in the lower part of the abdomen, either vertical or horizontal. Abdominal hysterectomy requires a longer healing time than vaginal or laparoscopic surgery. However, it is the approach of choice for a very large uterus, tumors, or if cancer might be present.
Vaginal hysterectomy is performed through the vagina. There is no incision on the abdomen and as a result healing time and post operative discomfort is less.
In laparoscopic assisted vaginal hysterectomy the uterus is still removed through the vagina but the upper portion of the uterus is detached using a laparoscope or small telescope through small incisions in the abdomen. This procedure is frequently performed if standard vaginal surgery cannot be performed. Recovery is similar to vaginal hysterectomy but it may take longer and has an increased risk of damage to other organs in the abdomen.
More recently, total laparoscopic hysterectomies have been performed using a robot for assistance. This approach frequently takes the longest of all the approaches to hysterectomy but offers the fastest recovery.
The risk of complications or problems occurring from hysterectomy is among the lowest for any major surgery but they do occur. The most common problems are infection, if all post operative temperature elevation is counted, and blood loss, although the need for transfusion is approximately one percent for all types of hysterectomies and conditions including long cancer operations. Other problems occur less and may include blood clots in the veins or lungs, bowel or bladder injury, and problems related to anesthesia. Very unusual or rare complications may also occur.
Depending upon the type of hysterectomy performed you may need to stay in the hospital for a few days. Generally, abdominal hysterectomies are associated with a two to three day stay while vaginal, laparoscopic, or robot assisted laparoscopic procedures are associated with shorter stays. During the immediate recovery you will be urged to walk around as soon as possible and deep breathe to help keep your lungs clear. Some pain is expected but is usually relieved by medications. There will also be some bleeding during recovery that gradually becomes a discharge before stopping. Do not put anything in the vagina during the first six weeks following hysterectomy, including douches, tampons or having sex.
Hysterectomy can have both emotional and physical effects which may last long term or short term. Menstrual periods will stop. If the ovaries are left in place they will continue to produce hormones but pregnancy does not occur. If the ovaries are removed before menopause, hormone related changes occur but they can be reduced by supplemental hormone use. Many women have emotional responses to the loss of the uterus. Some feel depressed since they can no longer have children but others are relieved or happy to be finished with periods. The same goes for sex. The emotional response varies widely between individuals, most have very little difficulty. Specific concerns should be addressed with your doctor prior to surgery.