What are the procedures for performing hysterectomy?
The type of hysterectomy you need depends upon the reason you need the surgery. In a total hysterectomy, the uterus and the cervix are removed. This is the most common kind of hysterectomy, usually performed for uterine and cervical cancer. When the fallopian tubes and ovaries are removed along with the uterus, it is called hysterectomy with bilateral salpingo-oophorectomy. This procedure may be performed to reduce the risk of ovarian cancer. A subtotal, or partial, hysterectomy removes only the uterus and is used to treat fibroids, abnormal bleeding, or pelvic pain.
A radical hysterectomy removes the uterus, cervix, ovaries, oviducts, fallopian tubes, top part of the vagina, lymph nodes, and lymph channels. It is performed when cervical or endometrial cancer has spread to the cervix, and has the longest recovery period. Hysterectomies can be performed abdominally or vaginally.
In addition to the different types of hysterectomy, there are different ways by which a gynaecologist might perform the operation. This will be influenced by the reason for performing the hysterectomy in the first place, the size of the uterus and the experience and preference of the individual gynaecologist. The choice depends upon your doctor and the type of hysterectomy you need.
With an abdominal hysterectomy, the surgeon makes a cut in the abdomen, similar to a cesarean section, through which he or she removes the uterus and other reproductive organs, if necessary. The uterus is removed through the abdomen via a surgical incision about six to eight inches long. This procedure is most commonly used when the ovaries and fallopian tubes are being removed, when the uterus is enlarged, or when disease has spread to the pelvic cavity, as in endometriosis or cancer. The main surgical incision can be made either vertically, from the navel down to the pubic bone, or horizontally, along the top of the pubic hairline. An abdominal hysterectomy accounts for most of the hysterectomies performed in the United States. It gives the surgeon a good view of the uterus and other reproductive organs, allows the surgeon to remove even large fibroids, and gives the surgeon room to work around and see any adhesions (scarring) from previous surgeries. However, abdominal hysterectomy does leave a scar, has some discomfort associated with the recovery period, and has a longer recovery period than the vaginal hysterectomy.
With a vaginal hysterectomy, the incision is made near the top of the vagina. The uterus is removed through the vaginal opening. This procedure is most often used in cases of uterine prolapse, or when vaginal repairs are necessary for related conditions. No external incision is made, which means there is no visible scarring. Through this incision, the surgeon can cut and tie off the ligaments, blood vessels, and fallopian tubes. The uterus is then cut free and removed through the vagina. The surgery and hospital stay are shorter than the abdominal hysterectomy and women usually return to normal activities after around four weeks. The vaginal hysterectomy is less painful than the abdominal procedure and leaves no exterior scar. However, if you have large fibroids or need more than just the uterus removed, the vaginal hysterectomy is not possible. Because it is difficult for the surgeon to actually see the uterus and surrounding tissue during the vaginal procedure, he or she may use a laparoscope. This is a slender tube equipped with a tiny camera and is inserted through a small incision below the belly button. The surgeon can then see the uterus on a television monitor. He or she uses small instruments inserted through two other tiny incisions in the abdomen to cut and tie off the blood vessels, fallopian tubes, and ligaments. The uterus is then removed though a small incision at the top of the vagina. The hospital stay is very short, and women generally recover within two weeks. However, only very skilled surgeons are able to perform the laparoscopic-assisted vaginal hysterectomy.