Abdominal And Vaginal Hysterectomy

What is a hysterectomy?

A hysterectomy is the surgical removal of the uterus, and most likely, the cervix. Depending on the reason for the surgery, a hysterectomy may involve removing surrounding organs and tissues, such as the fallopian tubes and ovaries. The uterus is where a fetus grows during pregnancy. Its lining is the blood you shed during your menstrual period. You won’t be able to get pregnant and you won’t get your period after a hysterectomy.

What are the different kinds of hysterectomy?

Your healthcare provider will discuss which type of hysterectomy is needed depending on your condition. This will determine if your fallopian tubes and/or ovaries need to be removed.

• Total hysterectomy: Removing your uterus and cervix, but leaving your ovaries.
• Supracervical hysterectomy: Removing just the upper part of your uterus while leaving your cervix.
• Total hysterectomy with bilateral salpingo-oophorectomy: Removing your uterus, cervix, fallopian tubes (salpingectomy) and ovaries (oophorectomy). If you haven't experienced menopause, removing your ovaries will start menopausal symptoms.
• Radical hysterectomy with bilateral salpingo-oophorectomy: The removal of your uterus, cervix, fallopian tubes, ovaries, the upper portion of your vagina and some surrounding tissue and lymph nodes. This type of hysterectomy is performed when cancer is involved.

Why is a hysterectomy performed?

Healthcare providers perform hysterectomies to treat:

• Abnormal or heavy vaginal bleeding that isn’t managed by other treatment methods.
• Severe pain with menses that isn’t managed by other treatment methods
• Leiomyomas or uterine fibroids (noncancerous tumors).
• Increased pelvic pain related to your uterus but not managed by other treatments.
• Uterine prolapse (uterus that has “dropped” into your vaginal canal due to weakened support muscles) that can lead to urinary incontinence or difficulty with bowel movements.
• Cervical or uterine cancer or abnormalities that may lead to cancer for cancer prevention.
• Conditions with the lining of your uterus, like hyperplasia, recurrent uterine polyps or adenomyosis.

How common is it to get a hysterectomy?

About 300,000 women get hysterectomies in the United States each year. It’s the second most common surgery performed among women (after Cesarean section).

PROCEDURE DETAILS

How do I prepare for a hysterectomy?

A healthcare provider will explain the procedure in detail, including possible complications and side effects. Talk to them about any concerns you have. You may be asked to provide blood and urine samples.

What happens during a hysterectomy?

Your healthcare provider will determine the type of hysterectomy you need and the best surgical method to perform that procedure. You’ll change into a hospital gown and get hooked up to monitors that track your heart rate. An intravenous (IV) line is placed in a vein in your arm to deliver medications and fluids.

An anesthesiologist will give you either:

• General anesthesia, in which you won’t be awake during the procedure; or
• Regional anesthesia (also called epidural or spinal anesthesia), in which medications are placed near the nerves in your lower back to “block” pain while you stay awake.

There are several different surgical approaches your healthcare provider may use to perform a hysterectomy:

Vaginal hysterectomy

• Your uterus is removed through an incision at the top of your vagina. There isn’t an external incision.
• Dissolvable stitches are placed inside your vagina.
• Most commonly used in cases of uterine prolapse and other nonmalignant (or noncancerous) conditions.
• Fewest complications and fastest recovery (up to four weeks) and considered the preferred approach.
• People often go home on the same day of surgery.

Laparoscopic hysterectomy

• A laparoscope (a thin tube with a video camera on the end) is inserted in your lower abdomen through a small incision in your belly button.
• Surgical tools are inserted through several other small incisions.
• Your uterus can be removed in small pieces through the incisions in your abdomen or through your vagina.
• Some people go home the same day or after one night in the hospital.
• Full recovery is shorter and less painful than an abdominal hysterectomy.

Robotic-assisted laparoscopic hysterectomy

• Your surgeon performs the procedure with the help of a robotic machine.
• A laparoscope is inserted in your abdomen so your pelvic area can be viewed.
• Small, thin surgical tools are inserted through three to five incisions around your belly button. Robotic arms and instruments are controlled by the surgeon.
• The recovery is similar to a laparoscopic hysterectomy.

Abdominal hysterectomy

• Your uterus is removed through a six- to eight-inch-long incision in your abdomen.
• The incision is made either from your belly button to your pubic bone or across the top of your public hairline. The surgeon will use stitches or staples to close the incision.
• Most commonly used when cancer is involved, when the uterus is enlarged or when disease spreads to other pelvic areas.
• It generally requires a longer hospital stay (two or three days) and a longer recovery time.

How long does a hysterectomy procedure last?

The procedure lasts one to three hours. The time can vary depending on the size of your uterus and the need to take down scarring from previous surgeries, as well as if other tissue, such as endometrial tissue, and other organs are being removed with your uterus (like your fallopian tubes or ovaries).

What are the most common side effects of a hysterectomy?

Some of the most common side effects of a hysterectomy are vaginal drainage (which may occur up to six weeks after surgery) and irritation at the incision sites.

If your ovaries were removed at the time of your hysterectomy, you may experience menopausal symptoms such as:

• Hot flashes.
• Vaginal dryness.
• Loss of libido.
• Difficulty sleeping (insomnia).

Your doctor will discuss treatment options to avoid the side effects of menopause mentioned above.

What happens after a hysterectomy?

The amount of time you spend in the hospital following a hysterectomy varies depending on what kind of surgery you had. Your healthcare provider will want to monitor you and ensure there aren’t any signs of complications like blood clots or bleeding. You’ll walk around as soon as possible after your surgery to prevent blood clots in your legs.

If you had an abdominal hysterectomy, you might stay in the hospital for a few days. Vaginal and laparoscopic hysterectomies are less invasive and typically don’t require an overnight stay in the hospital.

Your healthcare provider will go over recovery instructions, including restrictions to your day-to-day activities. Be sure to discuss any concerns you have about your recovery or the procedure.