HYSTERECTOMY SURGICAL REMOVAL OF UTERUS
Category: Obstetrics Gynecology
Abstract : Hysterectomy is the surgical removal of all or part of the uterus. In a total
hysterectomy, the uterus and cervix are removed. In some cases, the fallopian
tubes and ovaries are removed along with the uterus, which is a hysterectomy
with bilateral salpingo-oophorectomy. In a subtotal hysterectomy, only the
uterus is removed. In a radical hysterectomy, the uterus, cervix, ovaries,
oviduct
Hysterectomy is the surgical removal of all or part of the uterus. In a total
hysterectomy, the uterus and cervix are removed. In some cases, the fallopian
tubes and ovaries are removed along with the uterus, which is a hysterectomy
with bilateral salpingo-oophorectomy. In a subtotal hysterectomy, only the
uterus is removed. In a radical hysterectomy, the uterus, cervix, ovaries,
oviducts, lymph nodes, and lymph channels are removed.
The type of hysterectomy
performed depends on the reason for the procedure. In all cases, menstruation
permanently stops and a woman loses the ability to bear children.
Purpose
The most frequent reason for hysterectomy in American women is to
remove fibroid tumors, accounting for 30% of these surgeries. Fibroid tumors are
non-cancerous (benign) growths in the uterus that can cause pelvic, low back
pain, and heavy or lengthy menstrual periods. They occur in 30–40% of women over
age 40, and are three times more likely to be present in African-American women
than in Caucasian women. Fibroids do not need to be removed unless they are
causing symptoms that interfere with a woman’s normal activities.
Treatment of endometriosis is the reason for 20% of hysterectomies. The
endometrium is the lining of the uterus. Endometriosis occurs when the cells
from the endometrium begin growing outside the uterus. The outlying endometrial
cells respond to the hormones that control the menstrual cycle, bleeding each
month the way the lining of the uterus does. This causes irritation of the
surrounding tissue, leading to pain and scarring.
Twenty percent of hysterectomies are done because of heavy or abnormal
vaginal bleeding that cannot be linked to any specific cause and cannot be
controlled by other means. Another 20% are performed to treat prolapsed uterus,
pelvic inflammatory disease, or endometrial hyperplasia, a potentially
pre-cancerous condition. About 10% of hysterectomies are performed to treat
cancer of the cervix, ovaries, or uterus. Women with cancer in one or more of
these organs almost always have the organ(s) removed as part of their cancer
treatment.
Demographics
Hysterectomy is the second most common operation performed on
women in the United States. About 556,000 of these surgeries are done annually.
By age 60, approximately one out of every three American women will have had a
hysterectomy. It is estimated that 30% of hysterectomies are unnecessary.
The frequency with which hysterectomies are performed in the United States
has been questioned in recent years. It has been suggested that a large number
of hysterectomies are performed unnecessarily. The United States has the highest
rate of hysterectomies of any country in the world. Also, the frequency of this
surgery varies across different regions of the United States. Rates are highest
in the South and Midwest, and are higher for African-American women. In recent
years, although the number of hysterectomies performed has declined, the number
of hysterectomies performed on younger women aged 30s and 40s is increasing, and
55% of all hysterectomies are performed on women ages 35–49.Description A
hysterectomy is classified according to what structures are removed during the
procedure and what method is used to remove them.
Total hysterectomy
A total hysterectomy, sometimes called a simple
hysterectomy, removes the entire uterus and the cervix. The ovaries are not
removed and continue to secrete hormones. Total hysterectomies are usually
performed in the case of uterine and cervical cancer. This is the most common
kind of hysterectomy.
In addition to a total hysterectomy, a procedure called a bilateral
salpingo-oophorectomy is sometimes performed. This surgery removes the ovaries
and the fallopian tubes. Removal of the ovaries eliminates the main source of
the hormone estrogen, so menopause occurs immediately. Removal of the ovaries
and fallopian tubes is performed in about one-third of hysterectomy operations,
often to reduce the risk of ovarian cancer.
Subtotal hysterectomy
If the reason for the hysterectomy is to remove
uterine fibroids, treat abnormal bleeding, or relieve pelvic pain, it may be
possible to remove only the uterus and leave the cervix. This procedure is
called a subtotal hysterectomy (or partial hysterectomy), and removes the least
amount of tissue. The opening to the cervix is left in place. Some women believe
that leaving the cervix intact aids in their achieving sexual satisfaction. This
procedure, which used to be rare, is now performed more frequently. Subtotal
hysterectomy is easier to perform than a total hysterectomy, but leaves a woman
at risk for cervical cancer. She will still need to get yearly Pap smears.
Radical hysterectomy
Radical hysterectomies are performed on women with
cervical cancer or endometrial cancer that has spread to the cervix. A radical
hysterectomy removes the uterus, cervix, above part of the vagina, ovaries,
fallopian tubes, lymph nodes, lymph channels, and tissue in the pelvic cavity
that surrounds the cervix. This type of hysterectomy removes the most tissue and
requires the longest hospital stay and a longer recovery period.
Methods of hysterectomy
There are two ways that hysterectomies can be
performed. The choice of method depends on the type of hysterectomy, the
doctor’s experience, and the reason for the hysterectomy.
ABDOMINAL HYSTERECTOMY. About 75% of hysterectomies performed in the United
States are abdominal hysterectomies. The surgeon makes a 4–6-in (10–15-cm)
incision either horizontally across the pubic hair line from hip bone to hip
bone or vertically from navel to pubic bone. Horizontal incisions leave a less
noticeable scar, but vertical incisions give the surgeon a better view of the
abdominal cavity. The blood vessels, fallopian tubes, and ligaments are cut away
from the uterus, which is lifted out. Abdominal hysterectomies take from one to
three hours. The hospital stay is three to five days, and it takes four to eight
weeks to return to normal activities.
The advantages of an abdominal
hysterectomy are that the uterus can be removed even if a woman has internal
scarring (adhesions) from previous surgery or her fibroids are large. The
surgeon has a good view of the abdominal cavity and more room to work. Also,
surgeons tend to have the most experience with this type of hysterectomy. The
abdominal incision is more painful than with vaginal hysterectomy, and the
recovery period is longer.
VAGINAL HYSTERECTOMY. With a vaginal hysterectomy, the surgeon makes an
incision near the top of the vagina. The surgeon then reaches through this
incision to cut and tie off the ligaments, blood vessels, and fallopian tubes.
Once the uterus is cut free, it is removed through the vagina. The operation
takes one to two hours. The hospital stay is usually one to three days, and the
return to normal activities takes about four weeks.The advantages of this
procedure are that it leaves no visible scar and is less painful.
The
disadvantage is that it is more difficult for the surgeon to see the uterus and
surrounding tissue. This makes complications more common. Large fibroids cannot
be removed using this technique. It is very difficult to remove the ovaries
during a vaginal hysterectomy, so this approach may not be possible if the
ovaries are involved. Vaginal hysterectomy can also be performed using a
laparoscopic technique. With this surgery, a tube containing a tiny camera is
inserted through an incision inthe navel. This allows the surgeon to see the
uterus on a video monitor. The surgeon then inserts two slender instruments
through small incisions in the abdomen and uses them 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. This
technique, called laparoscopic-assisted vaginal hysterectomy, allows surgeons to
perform a vaginal hysterectomy that might otherwise be too difficult. The
hospital stay is usually only one day. Recovery time is about two weeks. The
disadvantage is that this operation is relatively new and requires great skill
by the surgeon. Any vaginal hysterectomy may have to be converted to an
abdominal hysterectomy during surgery if complications develop.
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