Hysterectomy is the surgical removal of all or part of the uterus. It may be advised in conditions like Fibroid, Endometriosis, Dysfunctional uterine bleeding, Pelvic inflammatory disease, cancer of cervix/ovary/uterus, Uterine prolapse, Endometrial hyperplasia, etc.
Depending on the reason for surgery, it may be:
- Subtotal hysterectomy- only the uterus is removed.
- Total hysterectomy- the uterus and cervix are removed.
- TAH with BSO (Total abdominal hysterectomy with bilateral salpingo-oopherectomy-uterus, cervix, fallopian tubes and ovaries are removed.
- Radical hysterectomy- uterus, cervix, fallopian tubes, ovaries, upper portion of vagina, lymph nodes, and lymph channels are removed.
PROCEDURE
It is done under general or regional anaesthesia.
It can be performed by two methods-
Abdominal - A 4–6 inch abdominal incision is given either horizontally across the pubic hair line or vertically from navel to pubic bone. The blood vessels, fallopian tubes, and ligaments are cut away from the uterus, which is lifted out.
Vaginal - An incision is given near the top of the vagina through which the ligaments, blood vessels, and fallopian tubes are tied off and the uterus is cut free. It is then removed through the vagina.
Vaginal hysterectomy can also be performed using a laparoscopic technique (LAVH) where a tube containing a tiny camera is inserted through an incision in the navel to visualize the abdominal cavity. Operating instruments are also inserted through small incisions in the abdomen to cut and tie off the blood vessels, fallopian tubes, and ligaments. When the uterus is detached, it is removed though a small incision at the top of the vagina.
It is also being performed as a Robotic surgery at some centres.
DURATION
The surgery takes from one to three hours. The hospital stay is three to five days for abdominal and one to three days for vaginal hysterectomy.
RECOVERY
Recovery is faster in vaginal hysterectomy, taking about four weeks to return to normal activities, while abdominal taking about four to eight weeks. Lifting of heavy objects or any other strenuous activity is to be avoided for at least four weeks. The menstrual periods are going to stop after hysterectomy. If ovaries are also removed, menopausal symptoms would start and few women may require hormone replacement therapy.
RISKS
- Bleeding
- Infection
- Damage to other organs like bladder or bowel
- Weight gain
- Pelvic pain