Indications
Your doctor may suggest you undergo a hysterectomy if you have the following conditions:
- Vaginal bleeding that continues despite treatment
- Uterine fibroids
- Endometriosis or persistent pelvic pain not cured by medicine or surgery
- Uterine prolapse - when the uterus descends into the vagina
- Cancer of the uterus, cervix, or ovaries - Dr Whittaker would likely refer you to a Gynaecological Oncologist for your surgery if a cancer was suspected or confirmed.
Types of Hysterectomy
Types of Hysterectomies include Subtotal, Total or Radical Hysterectomy.
Subtotal or supracervical hysterectomy is where the upper part of the uterus is removed, but the cervix is left in place.
A total hysterectomy involves removal of both the uterus and cervix. Radical hysterectomy is usually done in cases of cancer and involves removal of the uterus, tissue on the sides of the uterus, the upper part of the vagina, and the cervix.
It is very common to perform bilateral salpingectomy at the time of hystercomy, which means removal of both fallopian tubes. This is because there is no use for the fallopian tubes once your uterus has been removed, and we now know that some forms of ovarian cancer actually arise in the fallopian tubes.
Salpingo-oophorectomy may be performed along with hysterectomy in cases of an ovarian cyst. It is a procedure in which the fallopian tube and ovary on one side of the uterus are removed.
Bilateral salpingo-oophorectomy is where the fallopian tubes and ovaries on both sides of the uterus are removed. This results in menopause right away from the sudden drop in hormone levels.
Procedure
There are various ways to perform a hysterectomy.
Abdominal hysterectomy is where the incision is made through the skin and tissue in the lower abdomen to reach the uterus.
Laparoscopic hysterectomy uses a laparoscope to guide the surgery. A laparoscope is a thin, lighted tube that is inserted into the abdomen through a tiny incision in or around the umbilicus (belly button) which allows the surgeon to view the internal pelvic organs on a monitor.
Total laparoscopic hysterectomy is a method where the uterus is separated from inside the body and then removed through the vagina. The sutures at the top of the vagina are placed laparoscopically.
Laparoscopic-assisted vaginal hysterectomy uses a laparoscope to guide the surgery but the top of the vagina is stitched from the vaginal end. This approach may better allow repair of prolapse at the same time.
Vaginal hysterectomy is a method where the uterus is removed through the vagina. As the incision is made inside the vagina, healing time may be less than with abdominal surgery
Robot-assisted laparoscopic hysterectomy uses a robot attached to instruments to help perform the surgery through tiny incisions with a laparoscope.
Post-operative Care
Your length of stay and recovery depends on the type of surgery performed and the progress of your healing. You will be prescribed pain medications to keep you comfortable.
You will be instructed to get adequate rest and avoid heavy lifting after your surgery. You can continue normal activities once the pain, bleeding, and abdominal pressure has resolved. Sexual activity can be resumed after about six weeks following surgery (up to ten weeks after a laparoscopic hysterectomy). Exercises should be avoided until 3-6 weeks after surgery.
Recovery and return to activities of daily living are earlier in cases of women who have undergone vaginal or laparoscopic hysterectomy when compared to women who have undergone an abdominal hysterectomy. Generally, it takes around 4-6 weeks for complete healing from an abdominal hysterectomy and about 3-4 weeks of recovery from a laparoscopic or vaginal hysterectomy.
Complications
Most women recover without any complications from the surgery. However, Risks and Complications associated with Hysterectomy surgery can include the following:
- Infection
- Bleeding
- Blood clots in the leg or lung
- Urinary incontinence: loss of bladder control
- Vaginal prolapse: a condition in which the vagina protrudes from the vaginal opening.
- Chronic pain
- Bladder, bowel or ureter injury
- Painful intercourse or sexual dysfunction
- Early menopause if ovaries were removed
Call your doctor if you experience any of the following signs:
- Heavy vaginal bleeding
- Pain, redness, swelling, or discharge around the incisions
- Fever over 38 degrees
- Nausea and vomiting
- Shortness of breath
