What is a Hysterectomy?
A hysterectomy is a surgical procedure of removing the womb or the uterus. A woman is unable to get pregnant post-operation.
A total hysterectomy is a surgery that removes all of the uteri, including the cervix. The ovaries and the fallopian tubes may or may not be removed from a female’s body. This is the most common type of hysterectomy. There is also a partial, also called subtotal or supracervical hysterectomy that removes just the upper part of the uterus.
Why Hysterectomy Is Done?
Hysterectomy can be done for different reasons. They are:
- Uterine fibroids cause pain, bleeding.
- Severe pain with menses that is not controlled by other treatment methods
- Uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal
- Cancer of the uterus, cervix, or ovaries
- Endometriosis, where tissue similar to the tissue that normally lines the inside of the uterus grows outside the uterus.
- Abnormal vaginal bleeding
- Chronic pelvic pain
- Adenomyosis, or a thickening of the uterus
Hysterectomy for noncancerous reasons is usually considered only after all other treatment approaches have been tried without success.
What are the Types of Hysterectomy?
There are several types of Hysterectomy and after a proper check-up, a surgeon might choose to remove all or only part of the uterus. They are:
- Subtotal Hysterectomy: A supracervical or subtotal hysterectomy is the one that removes only the upper part of the uterus, keeping the cervix in place.
- Total Hysterectomy: A total hysterectomy is that which removes the whole uterus and cervix.
- Radical Hysterectomy: A radical hysterectomy is that which removes the whole uterus, tissue on the sides of the uterus, the cervix, and the top part of the vagina. Radical hysterectomy is generally only done when cancer forms in the patient’s body.
- There are other types such as when the surgeon removes the ovaries, it’s called Oophorectomy. When the tubes are removed that procedure is called Salpingectomy. When the entire uterus, both tubes, and both ovaries are removed, the entire procedure is called a Hysterectomy and Bilateral Salpingectomy-Oophorectomy.
What Are The Surgical Techniques For Hysterectomy?
Surgeons use different approaches for hysterectomy, depending on the surgeon’s experience, the reason for the hysterectomy, and the patient’s overall health. There are two approaches to surgery:
- An Open Surgery and
- A Minimally Invasive Procedure or MIP
Open Surgery Hysterectomy
An abdominal hysterectomy is open surgery. This is the most common approach to hysterectomy and surgeons generally opt for this approach after checking the overall patient’s health.
To perform an abdominal hysterectomy, a surgeon makes a 5- to 7-inch incision, either up-and-down or side-to-side, across the belly. Then the surgeon removes the uterus through this incision.
Following an abdominal hysterectomy, a person can usually spend 2-3 days in the hospital. There is also, after healing, a visible scar at the location of the incision.
MIP Hysterectomy
Using a MIP approach to remove the uterus offers several benefits when compared to the more traditional open surgery used for an abdominal hysterectomy. In general, a MIP allows for faster recovery, shorter hospital stays, less pain and scarring, and a lower chance of infection than does an abdominal hysterectomy.
Several approaches can be used for a MIP hysterectomy:
- Vaginal hysterectomy: The surgeon cuts the vagina and removes the uterus through this incision. The incision is closed, leaving no visible scar.
- Laparoscopic hysterectomy: This surgery is done using a laparoscope, which is a tube with a lighted camera, and surgical tools inserted through several small cuts made in the belly. The surgeon performs the hysterectomy from outside the body, viewing the operation on a video screen.
- Laparoscopic-assisted vaginal hysterectomy: The surgeon uses laparoscopic tools in the belly to assist in the removal of the uterus through an incision in the vagina.
- Robot-assisted laparoscopic hysterectomy: This procedure is similar to a laparoscopic hysterectomy, but the surgeon controls a sophisticated robotic system of surgical tools from outside the body. Advanced technology allows the surgeon to use natural wrist movements and view the hysterectomy on a three-dimensional screen.
With a MIP, people are generally able to resume their normal activity within an average of 3-4 weeks, compared to 4-6 weeks for an abdominal hysterectomy. The costs associated with a MIP are considerably lower than the costs associated with open surgery. However, the patient should consult her surgeon before undergoing any kind of approach to avoid any complications.
How A Patient Should Prepare Before The Surgery?
A hysterectomy is a serious surgery and one should be fit and healthy before the surgery. Good health before the operation will reduce the risk of developing complications and speed up recovery.
- The patient should strictly adhere to the instructions given by the doctor and maintain a good and balanced diet.
- The patient should stop smoking and excessive drinking
- She should eat a healthy, balanced diet
- She must exercise regularly
- She needs to lose weight if she is overweight
- She might need to have a pre-assessment appointment a few days before the operation.
- She should go for regular check-ups and some blood tests prescribed by the doctor to ensure she is fit for surgery.
How A Hysterectomy Is Performed?
There are 3 ways a hysterectomy can be performed. These are:
- Laparoscopic Hysterectomy
- Vaginal Hysterectomy
- Abdominal Hysterectomy
Laparoscopic Hysterectomy
Laparoscopic surgery is also known as keyhole surgery. It’s the preferred way to remove the organs and surrounding tissues of the reproductive system.
General anaesthesia is done before the surgery. During the procedure, a small tube containing a telescope (laparoscope) and a tiny video camera will be inserted through a small cut (incision) in the belly. This allows the surgeon to see the patient’s internal organs. Instruments are then inserted through other small incisions in the abdomen or vagina to remove the womb or cervix.
Vaginal Hysterectomy
A vaginal hysterectomy is performed by using:
- general anaesthetic – where the patient will be unconscious during the procedure
- local anaesthetic – where the patient will be awake, but will not feel any pain
- spinal anaesthetic – where the patient will be numb from the waist down
During a vaginal hysterectomy, the womb and cervix are removed through an incision that’s made in the top of the vagina. Special surgical instruments are inserted into the vagina to detach the womb from the ligaments that hold it in place. After the womb and cervix have been removed, the incision will be sewn up. The operation usually takes about an hour to complete.
A vaginal hysterectomy is usually preferred over an abdominal hysterectomy as it’s less invasive and involves a shorter stay in the hospital. The recovery time also tends to be quicker.
Abdominal Hysterectomy
A general anaesthesia is given to the patient before the surgery. During an abdominal hysterectomy, an incision will be made in the abdomen. It’ll either be made horizontally along the bikini line, or vertically from the belly button to the bikini line.
A vertical incision will usually be used if there are large fibroids (non-cancerous growths) if some type of cancer is formed. After the womb has been removed, the incision is stitched up. The operation takes about an hour to perform.
What A Patient Should Expect After Hysterectomy?
After a hysterectomy, a patient might feel tired and have some normal pain. Painkillers are provided to reduce pain and discomfort. Generally, post-surgery, a patient might feel some discomfort. Nurses opt for dressings over the wounds. A catheter is given to the patient that drains urine from the bladder into a collection bag. If a person undergoes abdominal surgery, she is provided with a drainage tube in the abdomen to take away any blood from beneath the wound. These tubes usually stay in place for 1 to 2 days. If someone goes for Vaginal Hysterectomy, a gauze pack is inserted into the vagina to minimise the risk of bleeding which usually stays in place for 24 hours.
The day after the operation, the patient will be encouraged to take a short walk. This helps the blood to flow normally, reducing the risk of complications developing, such as blood clots in the legs. A physiotherapist may show the patient how to do some exercises to help the mobility. They may also show some pelvic floor muscle exercises to help with the recovery. The Catheter is removed after a day and any stitches that need to be removed will be taken out 5 to 7 days after the operation.
The recovery time depends from patient to patient. The length of time it’ll take before the patient is well enough to leave the hospital depends on the age and level of health. If the patient has undergone a vaginal or laparoscopic hysterectomy, she may be able to leave between 1 and 4 days later. If the patient has undergone an abdominal hysterectomy, it’ll usually be up to 5 days before the patient is discharged. The GP in checked in for 4 to 6 weeks, but follow-up appointments with the hospital are not usually needed unless there are complications. It nearly takes about 6 to 8 weeks to fully recover after having an abdominal hysterectomy.
However, recovery times are often shorter after a vaginal or laparoscopy hysterectomy. During this time, the patient should rest as much as possible and not lift anything heavy, such as bags of shopping as abdominal muscles and the surrounding tissues need time to heal. One must get help from family or neighbours while she is recovering from the operation.
Generally, no such complications occurs but the patient should know and understand her health. If the ovaries are removed, the patient will be in menopause. If the ovaries are not removed, the patient may enter menopause at an earlier age rather than the real age.
Most people are told to abstain from sex and avoid lifting heavy objects for six weeks after hysterectomy. After a hysterectomy, most people surveyed said they feel the operation succeeded at improving or curing their main problem like heavy periods.
What Are The Most Common Side Effects Of A Hysterectomy?
Some of the most common side effects of a hysterectomy are vaginal drainage which may occur up to six weeks after surgery and irritation at the incision sites. If the patient’s ovaries were removed at the time of the hysterectomy, one may experience menopausal symptoms such as:
- Hot flashes.
- Vaginal dryness.
- Loss of libido.
- Insomnia
What are the possible risks of Hysterectomy?
The Patient that undergoes hysterectomy doesn’t face such serious problems or complications from the surgery. But a hysterectomy is major surgery so it might have some of the other risks. Those include:
- Urinary incontinence
- Part of the vagina might come out of the body
- Vaginal fistula formation that is an abnormal connection between the vagina and bladder or rectum.
- Chronic pain
Other risks from hysterectomy might include wound infections, blood clots, haemorrhage, or injury to surrounding organs.
What Should A Patient Do For A Quick Recovery?
- No lifting of heavy objects for at least six weeks.
- One should not put anything into the vagina and avoid sexual intercourse.
- Resuming exercise routine in four to six weeks.
- Eating healthy diet and taking the medicines as prescribed.
- The patient might take a shower. One should wash the incision with soap and water.
- One can resume driving after two weeks of abdominal surgery. In the case of vaginal or laparoscopic hysterectomy, one might begin driving within a few days.
- One must definitely go for routine check-ups to avoid complications.
Should A Patient Opt For A Hysterectomy?
Having a hysterectomy can help one live a more enjoyable life, especially if someone suffers from constant pelvic pain or heavy and irregular bleeding. If someone is at a higher risk of uterine cancer, a hysterectomy can lower this risk and potentially be life-saving.
However, a hysterectomy is a major surgery with a long recovery. It comes with risks and side effects and is permanent. Depending on the type of surgery one undergoes, she can go into menopause or experience symptoms of menopause. One won’t be able to conceive after the surgery.
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