A hysterectomy is surgery to completely or partially remove the womb (uterus). With hysterectomy, reproductive function ceases and the woman no longer menstruates and cannot get pregnant. During a hysterectomy, the ovaries and fallopian tubes can be removed together with the uterus, or only the uterus can be removed and the ovaries can be left.
What are the conditions that may require a hysterectomy?
- Uterine fibroids
- Heavy or unusual vaginal bleeding
- Uterine prolapse.
- Endometriosis
- Adenomyosis
- Cancer of the reproductive organs
- Endometrial Hyperplasia
- Pregnancy and labor complications
Types of hysterectomy
- Total Abdominal Hysterectomy – The entire uterus, including the cervix, is removed. But the ovaries and fallopian tubes are not removed.
- Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy (A) – The ovaries and fallopian tubes are removed along with the uterus.
- Total Abdominal Hysterectomy with Unilateral Salpingoopherectomy (B) – Only one ovary and fallopian tube are removed along with the uterus.
- Radical Hysterectomy – The uterus, cervix, ovaries, fallopian tubes, and nearby tissues are removed. Radical hysterectomy is most often used to treat certain types of cancer, such as cervical cancer.
- Supracervical hysterectomy – The upper part of the uterus is removed, but the cervix is left in place.
Hysterectomy can be performed with the following 3 different surgical methods:
Vaginal hysterectomy.
The uterus is removed through an incision made through the vagina. Since there is no incision in the abdomen, the patient’s recovery process is more comfortable and faster. The patient’s pain is also less. Vaginal hysterectomy usually causes fewer complications than abdominal or laparoscopic hysterectomy. However, not every patient is suitable for a vaginal hysterectomy.
Laparoscopic hysterectomy.
This method is also known as closed surgery. The laparoscope is a type of surgery based on viewing the inside of the abdomen through a camera. To perform a laparoscopic hysterectomy, the doctor inserts a camera and surgical instruments through small incisions in the abdomen. During surgery, the uterus is removed from the vagina. Compared to abdominal hysterectomy, laparoscopic surgery has advantages such as less postoperative pain and infection, shorter hospital stay, and faster recovery time.
Abdominal hysterectomy is the removal of the uterus through an incision made in the abdomen. The hospital stay is long in abdominal hysterectomy, and postoperative complications can be more.
Since hysterectomy is a difficult decision, the decision is made according to the patient’s age, cancer risk, pregnancy plan and whether there are alternative surgical methods. After the hysterectomy, the woman cannot become pregnant and if the ovaries are also removed, she will enter menopause. This usually undesirable. If the woman is young, has not yet entered menopause, and is planning a pregnancy, alternative surgical methods are evaluated to protect the uterus. For example myomectomy for uterine fibroids, sacrocolpopexy for uterine prolapse, endometriosis surgery for endometriosis and endometrioma, adhesiolysis for adenomyosis, oophorectomy for ovarian cyst. However, in cases with cancer or cancer risk, unfortunately, removal of the uterus may be inevitable.
