Hysterectomy (Removal of Womb)

 

Mr Davis is a specialist in laparoscopic (key-hole) surgery for gynaecology. He performs regular laparoscopic hysterectomies in London in his Private practice.

What is a hysterectomy?

 

Hysterectomy surgery is an operation to remove a woman's uterus or womb. The whole uterus (total hysterectomy) or the main part leaving the cervix (subtotal hysterectomy) may be removed. After a hysterectomy menstrual periods do not occur and the operation is used as a last resort to treat gynaecological conditions such as severe pelvic pain and extremely heavy periods. The ovaries are not routinely removed at the same time as this will cause the natural oestrogen levels to fall and hot flushes and night sweats will result.

How is hysterectomy surgery performed?

 

There are different ways hysterectomy surgery can be performed. It will depend on your health history and the reason for your surgery.

Abdominal hysterectomy

This is done through a 5- to 7-inch incision, or cut, in the lower part of your tummy. The cut is usually across your tummy, just above your pubic hair (bikini-like, Pfannenstiel incision). There are occasions when an up and down (midline incision) is necessary.

Vaginal hysterectomy

This is done through a cut in the vagina. The uterus will be removed through the vaginal incision and the vagina closed with stitches.

Laparoscopic hysterectomy

A laparoscope is an instrument with a thin, lighted tube and small camera that allows the pelvic organs to be visualised. Three to four small cuts in the tummy are made to insert the laparoscope and other instruments. The uterus will be will cut your uterus into smaller pieces (morcellated) and remove them through the small incisions.

Laparoscopically assisted vaginal hysterectomy (LAVH)

The main part of the surgery is performed using the laparoscope and small tummy incisions. The uterus is then removed through the vagina.

Robotic-assisted surgery

A Robotic device allows the surgeon to sit at a terminal and operate robotic arms to perform surgery. Much like a laparoscopic hysterectomy (see above) small incisions are made in the tummy. It is a relatively new technique for gynaecology and is only available in a few hospitals in the UK.

Why do women have hysterectomies?

 

Hysterectomy surgery may be needed for the following conditions:

Cancer of the uterus, ovary, cervix, or endometrium. Hysterectomy may be the best option if there is cancer in these organs. The endometrium is the tissue that lines the uterus. If there are precancerous changes of the cervix, it might be better for a loop electrosurgical excision procedure (LLETZ) to remove the cancerous cells.

Fibroids

Fibroids are non-cancerous, muscular tumors that grow in the wall of the uterus. Many women with fibroids have only minor symptoms and do not need treatment. Fibroids also often shrink after menopause. In some women, fibroids can cause prolonged heavy bleeding or pain. Fibroids can be treated with medications. There are also procedures to remove the fibroids, such as uterine artery embolization (UAE), which blocks the blood supply to the fibroids. Without blood, the fibroids shrink over time, which can reduce pain and heavy bleeding. Another procedure called myomectomy removes the fibroids whilst leaving the uterus intact, but there is a risk that the tumors could come back. If medications or procedures to remove the fibroids have not helped, and a woman is either near or past menopause and does not want children, hysterectomy can cure problems from fibroids.

Endometriosis

This health problem occurs when the tissue that lines the uterus (endometrium) grows outside the uterus on your ovaries, fallopian tubes, or other pelvic or abdominal organs. This can cause severe pain during menstrual periods, chronic pain in the lower back and pelvis, pain during or after sex, bleeding between periods, and other symptoms. A hysterectomy may be required when medications or less invasive surgery to remove the spots of endometriosis have not helped.

Prolapse of the uterus.

This is when the uterus slips from its usual place down into the vagina. This can lead to urinary and bowel problems and pelvic pressure. These problems might be helped for a time with an object called a vaginal pessary, which is inserted into the vagina to hold the uterus in place.

Adenomyosis

PIn this condition, the tissue that lines the uterus (endometrium) grows inside the walls of the uterus (myometrium), which can cause severe pain. If other treatments have not helped, a hysterectomy is the only certain cure.

Chronic pelvic pain

Surgery is a last resort for women who have chronic pelvic pain that clearly comes from the uterus. Many forms of pelvic pain are not cured by a hysterectomy, so it could be unnecessary and create new problems.

Abnormal vaginal bleeding

Treatment depends on the cause. Changes in hormone levels, infection, cancer, or fibroids are some things that can cause abnormal bleeding. There are medications that can lighten heavy bleeding, correct irregular bleeding, and relieve pain. These include hormone medications, birth control pills, and non-steroidal anti-inflammatory medications (NSAIDs). One procedure, endometrial ablation, uses a balloon device to heat the lining of the uterus and can help stop heavy, prolonged bleeding. But, it should not be used if a woman wishes to become pregnant. Very rarely, hysterectomy is needed to control bleeding during a cesarean delivery following rare pregnancy complications. There are other methods doctors use to control bleeding in most of these cases, but hysterectomy is still needed for some women.

Types of hysterectomy:

 

- Partial, subtotal, or supracervical removes the main part of the uterus. The cervix is left in place.

- Total hysterectomy removes the whole uterus and the cervix.

- Radical removes the whole uterus, the tissue on both sides of the cervix, and the upper part of the vagina. This is done mostly when there is cancer present.

How long does it take to recover from hysterectomy surgery?

 

Recovering from a hysterectomy does take time. Most women stay in the hospital from 1 to 2 days for post-surgery care. Some women may stay longer, often when the hysterectomy is done through an abdominal incision.

PThe time it takes for you to resume normal activities depends on the type of surgery. If you had:

Abdominal surgery

Recovery takes from 6 to 8 weeks. You will gradually be able to increase your activities.

Vaginal or laparoscopic surgery

Recovery takes 3 to 4 weeks. You should get plenty of rest and not lift heavy objects for a full 6 weeks after surgery. About 6 weeks after either surgery, you should be able to have baths and resume sexual intercourse.

What are the risks of having a hysterectomy?

 

Most women do not have health problems during or after the surgery, but some of the risks of a hysterectomy include:

  • Injury to nearby organs, such as the bowel, urinary tract, bladder, rectum, or blood vessels
  • Pain during sexual intercourse
  • Early menopause, if the ovaries are removed
  • Anaesthetic problems, such as breathing or heart problems
  • Allergic reactions to medicines
  • Blood clots in the legs or lungs.
  • Infection
  • Heavy bleeding

Complications following hysterectomy surgery are uncommon and many measures are taken to avoid problems arising.

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