Hysterectomy
Why have a hysterectomy?
The vast majority of women who have a hysterectomy for a genuine reason have a vastly improved quality of life afterwards and wish they had had it done much sooner.
Types of Surgery for Hysterectomy
Abdominal Hysterectomy
This is done through a cut in the abdomen which may be horizontal in the bikini line or vertical from the belly button. Abdominal hysterectomy may include removal of the uterus, ovaries, fallopian tubes and cervix in which case it is a Total Abdominal Hysterectomy and bilateral salpingo-oophorectomy. If the cervix is left behind it is an abdominal sub-total hysterectomy and can be done with or without removal of the ovaries and fallopian tubes
Vaginal hysterectomy
The uterus is removed through the vagina and there is no visible scar. The ovaries and fallopian tubes may be removed at the same time but can be difficult if access is poor or there is no prolapse or there has been previous surgery.This procedure is very often done in conjunction with a vaginal repair for prolapse of the uterus and the vaginal walls
Keyhole (Laparoscopic) Hysterectomy
For this for surgery 3 or 4 small incisions are made on the abdomen and in the belly button. The abdomen is filled with carbon dioxide gas which makes a space for the surgeon to be able to see inside the abdomen. To do this he uses a telescope with a camera lead which transmits the picture onto a video monitor. The options for laparoscopic hysterectomy are laparoscopically assisted vaginal hysterectomy (part laparoscopic, part vaginal), total laparoscopic hysterectomy (the uterus and cervix are removed) or laparoscopic subtotal hysterectomy (the cervix remains) all of which may be with or without the removal of the ovaries and the fallopian tubes.
What is a Hysterectomy
A hysterectomy is the removal of the uterus with or without the removal of the ovaries and cervix. There are several different types of hysterectomy; abdominal, vaginal, laparoscopically assisted vaginal or laparoscopic.
Conditions associated with having a hysterectomy:-
- Painful periods
- Heavy periods
- Uterine fibroids
- Uterine prolapse
- Endometriosis
- Adenomyosis
- Chronic pelvic inflammatory disease
- Cancer of cervix, uterus or ovaries
A hysterectomy is considered if less radical treatments listed below are unsuitable or have failed:-
- minor surgery like TCRE, balloon ablation, hydrothermal ablation destroys the lining of the uterus reduces or stops heavy periods
- mirena coil (hormone releasing intrauterine device to treat heavy periods)
- myomectomy which is surgery to remove fibroids
- uterine artery embolisation treats fibroids
- hormone treatment and surgical treatment for endometriosis
What determines the type of hysterectomy you will have?
Abdominal
If you are unable to have a vaginal hysterectomy or keyhole surgery because your uterus is too big with fibroids, or you have had caesarian sections that have caused adhesions and scars. If you have cancer the surgeon may prefer to do the surgery as an open procedure.
Vaginal
This is usually done for ladies that have vaginal prolapse as well.
Keyhole
Most hysterectomies can be done laparoscopically (keyhole surgery) however, this does depend on the skill of your surgeon. It is very important to find a surgeon that is capable and has experience in doing this type of surgery. Recovery from keyhole surgery is much quicker and you will go home in a day or two. The discomfort is far less as you only have a few little incisions. There may be a little discomfort from the gas but that disperses fairly quickly once you are up and about.
The one danger from having this type of surgery is that you do too much too quickly.