Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures. If you are still having your periods, a hysterectomy will stop them and you will no longer be able to get pregnant.
Usually performed by a gynecologist, hysterectomy may be total (removing the body, fundus, and cervix of the uterus; often called "complete") or partial (removal of the uterine body while leaving the cervix intact; also called "supracervical"). It is the most commonly performed gynecological surgical procedure.
When is Hysterectomy Surgery required to be done ?
Hysterectomy is usually done in case of severe disease or abnormality within the uterus and is usually considered as the last option. This is because after this surgery the female body undergoes a change because of sudden disruptions in the female hormonal levels. This affects the overall health of the female for the rest of her life. Indications for hysterectomy include tumours of the reproductive system (uterus, cervix, ovaries), chronic pelvis pain, endometriosis (inflammation of the inner lining of the uterus), uterine fibroids and 2nd or 3rd degree uterine prolapse (uterus descends down towards the mouth of vagina due to weakened supporting ligaments), persistent vaginal bleeding during the menstrual cycle.
Sometimes it may have to be removed just after childbirth due to abnormal position of the placenta (cord that attaches the baby to the uterine walls) or excessive post partal bleeding. In very rare cases the hysterectomy may be carried out as a prophylactic measure in cases of strong family history of reproductive system cancers (like breast cancer) or in the presence of any developmental abnormality.
Different types of Hysterectomy Surgery
Radical Hysterectomy - In this procedure along with the removal of the uterus, ovaries, fallopian tubes, cervix, upper vagina, connective tissue surrounding the uterus and the nearby lymph nodes are also removed. This generally indicated in cancers of the uterus.
Total Hysterectomy - In this procedure the entire uterus along with the cervix is removed. The other organs are left intact.
Subtotal Hysterectomy - In this procedure only the body of the uterus is removed. The cervix is kept in place.
Different Techniques used for Hysterectomy
There are three different techniques used for hysterectomy - Abdominal, Vaginal and Laparoscopic.
Abdominal Hysterectomy : is the oldest techniques in which the uterus is accessed through a horizontal or vertical incision of 5"-7" made in the lower part of the abdomen (just above the pubic line). This procedure is generally used for radical hysterectomy as the entire reproductive complex can be viewed and explored through this incision. Since this procedure involves the cutting of abdominal muscles, recovery after this surgery is slow to allow healing of the muscles. It generally takes 6 months for complete recovery.
Vaginal Hysterectomy was an improvement over the abdominal technique. The uterus is removed through the vaginal canal by making a small circular incision in the upper part of the vagina. This procedure is indicated in case of uterine prolapse. Since the incision is small it requires a shorter healing time and a shorter hospital stay. The complications and occurrence postoperative infection is also less as compared to abdominal hysterectomy.
LAPAROSCOPIC ASSISTED HYSTERECTOMY is a modern minimally invasive technique with lesser post-operative complications and rapid recovery for the patient.
Total Laparoscopic Hysterectomy involves making three or four small cuts in the abdomen near the belly button. A laparoscope is inserted through the incisions into the abdominal cavity. The video imaging of the insides of the pelvic cavity through the laparoscope gives a clearer picture to the surgeon as compared to the traditional abdominal approach. Surgical instruments are inserted through the laparoscope into the belly and the uterus is cut into small pieces. The pieces are then removed through the small incisions made in the abdomen.
Laparoscopic assisted Vaginal Hysterectomy nvolves inserting a laparoscope through 2-3 small cuts in the abdomen near the navel, visualising the uterus and the surrounding areas, detaching the uterus and then removing it through the vagina.
Laparoscopic- assisted Supracervical Hysterectomy removes the uterus without removing the cervix using a morcellator which cuts the uterus into small pieces that can be removed from the abdominal cavity via the laparoscopic ports.
Robotic Laparoscopy Hysterectomy is a variant of laparoscopic surgery using special remotely controlled robotic instruments that allow the surgeon finer control as well as three-dimensional magnified vision.
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