Hysterectomy


 

A hysterectomy is the surgical removal of a woman’s uterus. It may be done to treat fibroids, endometriosis, uterine prolapse, cancer, chronic pain, or heavy bleeding that has not been controlled by less invasive methods. 

A hysterectomy is typically necessary when all other options including medication, therapies and even other surgeries have not been successful and the patient’s life is at risk or her quality of life is being harmed. Hysterectomies are the most common surgery performed exclusively on women.

A hysterectomy can simply mean the removal of the uterus, or it can mean removal of the uterus, cervix and ovaries. In addition, it can be performed in several ways. 


Types of hysterectomies

  • Total or complete hysterectomy - The uterus and the cervix are removed. 
  • Supracervical (also called subtotal or partial) hysterectomy - The upper portion of the uterus is removed, leaving the cervix and ovaries intact. 
  • Radical hysterectomy – A hysterectomy occasionally used to treat cervical cancer. During a radical hysterectomy, extra tissue is removed from the area surrounding the uterus.


Note: - All types of hysterectomy end a woman's ability to become pregnant. Also, surgeries that include the removal of the ovaries cause menopause to set in after surgery, if you have not already entered menopause.



Ways to perform Hysterectomy

There are several ways Hysterectomy can be performed; some methods are more invasive than others.

Risks - The risks for any surgery are:

  • Allergic reactions to medicines
  • Breathing problems
  • Blood clots in your leg or pelvic veins that may travel to your lungs. These can be fatal.
  • Bleeding
  • Infection
  • Injury to nearby organs, including the bladder, ureters, or blood vessels
  • Injury to bowels (intestines)
  • Pain during sexual intercourse
  • Early menopause, if the ovaries are also removed 

Recovery time after the procedure - Complete recovery may take 2 weeks to 2 months. Recovery from a vaginal or laparoscopic hysterectomy is faster than recovery from an abdominal hysterectomy. It may also be less painful. Average recovery times are: 

  • Abdominal hysterectomy -- 4-6 weeks.
  • Vaginal hysterectomy -- 3-4 weeks.
  • Laparoscopic or robotic hysterectomy – 2-4 weeks.


Side Effects – 

For the majority of women who have a hysterectomy each year, their quality of life is improved by the surgery as pain, bleeding, concerns about pregnancy and disease are alleviated. Those in the minority, who find a hysterectomy to be a very negative experience, usually attribute those feelings to the inability to have children after the procedure. One of the negative side effects of having a hysterectomy may be the onset of menopausal symptoms. Those who have the ovaries removed will begin those symptoms after surgery, but those who retain their ovaries frequently experience menopause earlier than is typical. After surgery hormone replacement may be necessary. There are risks associated with hormone treatment, but those risks need to be balanced against the risks for osteoporosis and other conditions and should be discussed with your health care provider. You will still need regular Pap tests to screen for cervical cancer if you had a partial hysterectomy and did not have your cervix removed, or if your hysterectomy was for cancer. Ask your doctor what is best for you and how often you should have Pap tests. Even if you do not need Pap tests, all women who have had a hysterectomy should have regular pelvic exams and mammograms.


  1. Abdominal Hysterectomy

This hysterectomy is performed using an incision in the abdomen that can be either vertical from the area of the pubic bone up toward the belly button, or it may be horizontal along the bikini line. 


  1. Vaginal Hysterectomy

This hysterectomy is performed entirely through an incision made in the vagina. This describes a surgical procedure in which the uterus is removed through the vagina. One or both ovaries and fallopian tubes may be removed during the procedure as well. This surgical approach avoids visible scarring and typically allows for a quicker recovery, as well as less postoperative pain and complications as compared with other types of hysterectomy. 

Risks – Risks associated with the vaginal approach include a slight risk of shortening or damaging the vagina.The post hysterectomy pain reported after a vaginal hysterectomy is much less than that experienced with an abdominal surgery, and this means fewer pain medications to control the pain. There is also typically a shorter hospital stay, sometimes only a day or two, and this can mean cost savings as well. 

How is it performed – With a vaginal hysterectomy an incision is made around the cervix and the removal of the uterus is done entirely through the vagina. If the uterus is very large or if cancer is suspected, a vaginal hysterectomy probably is not the best choice to remove the uterus.

​The symptoms after hysterectomy that you experience with a vaginal procedure can include bleeding from the vagina and pain which is mild to moderate. In some cases, a vaginal procedure may turn into an abdominal incision if any complications or unexpected circumstances are present.

Notify your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Nausea and/or vomiting
  • Dizziness or fainting
  • Cough, shortness of breath, or chest pain
  • Heavy bleeding
  • Pain that you cannot control with the medications you have been given
  • Pain, burning, urgency or frequency of urination, or persistent bleeding in urine
  • Swelling, redness, or pain in your leg


  1. Laparoscopic Assisted Hysterectomy

This is any hysterectomy using the vaginal approach with assistance from laparoscopic instruments inserted through tiny incisions in the abdomen. This is one of the newest surgical methods used to perform a hysterectomy is the laparoscopic method, and this type of surgery has the shortest hysterectomy recovery time. Many women are able to return to work two to three weeks after surgery. With a laparoscopic hysterectomy, two or three small incisions are made, and then a thin tube with a camera is inserted into one of the small incisions. Any surgical tools needed are inserted into the other incisions, and the uterus is usually freed up from the surrounding tissue and removed through the vagina. This method usually has the fewest symptoms after hysterectomy, and involves less pain and discomfort while you are recovering. This method also involves the smallest possible incisions, and any scarring is minimal. 

Risk

The risk of infection with this method of surgery is very small, because the incisions are smaller and heal faster. 

Benefits of laparoscopy include:

  • Excellent visualization of the pelvis
  • The procedure can often be done outpatient, or involves an overnight hospital stay
  • Less pain medication is required
  • Fewer complications
  • Smaller scars

What kind of recovery can be expected?

Patients should expect to take ibuprofen or narcotic pain pills for a few days post-operatively. It is encouraged for patients NOT to stay in bed. They should move around the house and resume normal activities as soon as they feel up to it. Some women are well enough to return to work one to two weeks after surgery. Women who have more physically demanding work should stay home for 3-6 weeks. Women can resume exercise and intercourse within six weeks of the surgery.

Laparoscopic patients can expect to suffer less post-operative pain than traditional hysterectomy or cesarean section patients.

After you leave the hospital, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, leakage, or any discharge from the incision site
  • Incision opens up
  • Nausea and/or vomiting
  • Dizziness or fainting
  • Cough, shortness of breath, or chest pain
  • Heavy bleeding
  • Pain that you cannot control with the medications you have been given
  • Pain, burning, urgency or frequency of urination, or persistent bleeding in urine
  • Swelling, redness, or pain in your leg


  1. Robotic-assisted surgery

This hysterectomy uses a special machine (robot) to do the surgery through small cuts in your belly, much like a laparoscopic hysterectomy. Dr. Navita Modi has received specialized training to perform surgical procedures with the da Vinci robotic system. The da Vinci Surgical System is a robotic surgical system approved by FDA. It is designed to facilitate complex surgery using a minimally invasive approach, and is controlled by a surgeon from a console. The system is commonly used for prostatectomies, and increasingly for cardiac valve repair and gynecologic surgical procedures. Robotic surgery, with its 3-D optics, magnification and flexible or articulating wrists, enables surgeons to perform complex surgical procedures with greater precision in a minimally invasive technique that previously required a large, open incision.

 

Pros of da Vinci Robotic Surgery

  • Better precision: The doctor sits at a computer screen that magnifies all the intricacies of the surgery, allowing them to see much more clearly. They can also reach things more easily with the small robotic arms than with the average human hand.
  • Faster recovery time: Robotic surgeries are less invasive than other types of surgery, so recovery time is usually shorter.
  • Less blood loss: The incision required for robotic surgeries is much smaller than typical surgeries, so less blood is lost during the procedure.
  • Less scarring: Because the incision for robotic surgery is considerably smaller, the scar is much less noticeable.

Cons of da Vinci Robotic Surgery

  • Device malfunction: Although this risk is very rare, there are those times when a robotic machine can malfunction and cause more serious problems during surgery. In these rare instances, doctors have to quickly perform another type of operation to correct the damage and fix the original issue.
  • Possible burns, cuts or tears to surrounding organs: There’s another slight risk of the robotic hand getting too close to another organ during surgery, causing damage. Because of the precision of the da Vinci systems, this complication is also very rare.
  • Doctor lacking in experience or training: Most complications, if any, stem from a doctor’s lack of experience or training to perform da Vinci robotic surgeries. If you decide to have a procedure done robotically, one of the most important things is to make sure your doctor has ample experience.


For the patients, benefits may include:

  • Shorter recovery time
  • A faster return to normal daily activities
  • And in many cases, better clinical outcomes
  • Significantly less pain
  • Less blood loss
  • Less scarring
Location
Women's Health Care Specialists
7525 Greenway Center Dr, Suite 202
Greenbelt, MD 20770
Phone: 301-304-1546
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301-304-1546