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What is a Hysterectomy?

    • For women who may be told they need a hysterectomy, it’s vital to be sure just what that means.

      The word “hysterectomy” is used to describe the removal of the uterus (womb) for the body. But the uterus is just part of the complex reproductive system within a woman, so the term hysterectomy might not cover all the important details.

      In addition to removal of the uterus, you and your surgeon may be talking about removal of other structures – including the ovaries (which produce eggs), the fallopian tubes (which carry the eggs to the uterus) and in some cases the cervix, the lower end of the uterus that meets the top of the vagina.

      “Each woman’s situation will be different,” says San Francisco gynecologist Andrew I. Brill, M.D., director of minimally invasive gynecology at California Pacific Medical CenterOpens new window. “The type of procedure needed will vary depending on the woman’s particular medical issue, her health status, age, physical size and personal preferences. It is vital to have a detailed conversation about her unique needs, so she understands her options and can make an informed decision that is right for her.”

      A number of hysterectomy alternatives might be explored before a surgical option is considered.

    • Types of Hysterectomy

    • If a surgical option is needed, there are several possibilities:

      • Partial hysterectomy – also called subtotal or supracervical hysterectomy. This operation removes the majority of the uterus/womb, leaving the cervix in place.
      • Total hysterectomy removes the uterus and the cervix (lower opening to the uterus). The top of the vagina remains in place.
      • Radical hysterectomy may be needed if invasive cancer is present. This procedure removes the uterus and cervix and may extend to other surrounding tissues.

      Whether or not to remove the cervix at the time of the hysterectomy will be determined by the medical needs of the woman.

    • Removing Ovaries or Fallopian Tubes with Hysterectomy

    • Outside of the question of removing the entire uterus or just part of the uterus, the woman and her physician should discuss whether it is necessary or desirable to remove the fallopian tubes and ovaries.

      According to Dr. Brill, the removal the fallopian tubes is often recommended, as they are no longer necessary for fertility, and there is evidence that they may be linked to future ovarian cancer.

      Removal of the ovaries before menopause, however, will impact the woman as the hormones they deliver to the body will be abruptly absent. Without ovaries, a woman will experience “surgical menopause” with all the typical symptoms of menopause.

      “If possible, women should keep their ovaries intact,” says Dr. Brill. For those with a family history of ovarian cancer, or other reasons why it is advisable to remove the ovaries, the patient can receive hormonal treatments to ease the symptoms of surgical menopause. (Concerned about HRT? Read more: Is hormone therapy safe?)

      Dr. Brill notes that for most conditions dictating a hysterectomy,a woman can have just the top of the uterus removed, retaining the vagina and cervix, as well as her ovaries and their hormonal function. “Women come to me seeking to avoid a hysterectomy,” he notes. “In many cases, after a careful explanation of the procedure, these women do have a minimally invasive type of hysterectomy. They realize that the impact to their lifestyle will be minimal, and their problem of pain or heavy uterine bleeding will be removed.”

    • Types of Hysterectomy Surgery

    • In addition to considering the extent of surgery needed based on medical needs, the woman and her physician should discuss the method of surgery. Historically, a hysterectomy meant a large abdominal incision, a long hospital stay and a six-week recovery period. Now many options exist that result in quicker recovery time and smaller, less noticeable scars.

      Dr. Brill advises women to seek out doctors with the appropriate equipment and training for less invasive surgeries, since these may not be available to physicians in all communities. “It is important for a woman to ask her doctor about his or her skill and experience in the procedure being recommended,” notes Dr. Brill. “There is a real advantage to having your surgery in a center devoted to advanced surgical techniques, and performed by a physician who has a long track record of success with the procedure in question.” (See 10 questions to ask your doctor before a hysterectomy.)

    • Methods of Hysterectomy

      • Abdominal hysterectomy (traditional) This is done through a 5 to 7-inch incision in the lower part of your belly. The incision may go either horizontally or vertically, just above your pubic hair. The uterus is lifted out of the incision.
      • Vaginal hysterectomy. This is done through a cut in the vagina, with no opening in the abdominal wall. The uterus is removed through the vaginal incision.
      • Laparoscopically assisted vaginal hysterectomy (LAVH). The uterus is removed through the vagina, as described above, but the surgery is assisted by a laparaoscope inserted through small incisions in the abdomen.
      • Laparoscopic supracervical hysterectomy (LSH). The surgery requires three to four small incisions in the abdomen to insert the scope and other instruments. The uterus is cut into smaller pieces and removed through these small incisions.
      • Laparoscopic total hysterectomy (TLH). Like LSH, the surgery requires three to four small incisions in the abdomen to insert the scope and other instruments. After the uterus is cut free it is removed vaginally.
      • Robotic-assisted surgery. In some cases, the actual surgical procedure is performed by a “robotic system” which is guided by the doctor viewing the laparoscopic camera. For many gynecologists, robotic surgery enables them to perform this surgery.

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