Definition and Overview
Hysterectomy is a surgical procedure that removes the uterus. It can be complete (the entire uterus including the cervix is removed) or partial, where only the uterus is removed.
Statistics show that hysterectomy is the most commonly performed surgical procedure in the field of gynaecology, with over 600,000 operations performed annually in the United States alone.
It is important to note that undergoing hysterectomy prevents the patient from having children in the future and has a life-long effect on the patient’s hormonal balance. As an irreversible surgical treatment, it is only recommended as a last resort when other forms of treatment failed to correct the patient’s condition.
Who Should Undergo and Expected Results
This uterus removal procedure is typically recommended for patients with cancers of the female reproductive system or those who have a higher risk of developing such conditions. These include:
- Uterine cancer
- Ovarian cancer
- Cancer of the endometrium
- Cervical cancer
Uterus removal is also a last-resort treatment prescribed to patients with serious tumors or cysts in their reproductive organs, including fibroids growing in the uterus that cannot be treated with other forms of medication or minimally invasive procedures.
Other conditions that can be corrected with this procedure include:
- Obstetrical hemorrhage
- Placenta praevia – A placenta that formed inside or over the birth canal
- Placenta percreta - A placenta that grew through the uterine wall and has attached itself to surrounding organs
- Chronic pelvic pain
- Vaginal prolapse
Patients undergoing gender transition (female to male) are also candidates for a uterus removal procedure to complete the transition process. In this case, hysterectomy is performed before the gender reassignment.
How is the Procedure Performed?
As mentioned earlier, the uterus removal procedure can be either complete or partial. The gynaecological surgeon can use different surgical techniques based on the reason for the procedure and the patient’s overall health. There are also two basic approaches: open or minimally invasive surgery.
Open surgery is a common approach and used in more than half of all hysterectomy procedures performed all over the world. This is carried out under either general anaesthesia or sedation and requires a five to seven-inch incision in the abdomen to access the uterus. The organ will then be disconnected from neighboring structures (or in some cases, the neighboring structures such as the fallopian tubes, ovaries, and cervix will also be removed) before the incision is sewn up using small sutures. This approach requires the patient to stay in the hospital for at least three days after the operation.
The uterus can also be removed using minimally invasive methods, such as the following:
Laparoscopic hysterectomy – This involves the use of a laparoscope (a thin, tube-like tool with a camera and light attached on one end) and other surgical tools that are inserted through small incisions made in the patient’s abdomen.
Vaginal hysterectomy – This involves making a small incision in the vagina where the doctor can extract the uterus from. This is the best option for patients who do not want visible scarring on their abdomen.
Possible Risks and Complications
Although generally safe, hysterectomy can result in the following complications:
- Urinary incontinence
- Vaginal prolapse
- The formation of fistula (abnormal connections) between the bladder and vagina
- Chronic pain
- Blood clots
- Injury or perforation of the surrounding structures and organs
American College of Obstetricians and Gynecologists. Committee Opinion No. 444: Choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2009 (Reaffirmed 2011);114:1156-8. PMID: 20168127 www.ncbi.nlm.nih.gov/pubmed/20168127.
Giudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010 Jun 24;362(25):2389-98. PMID: 20573927 www.ncbi.nlm.nih.gov/pubmed/20573927.
Jones HW III. Gynecologic surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 71.