Hysterectomy

Answer 1

Definition

A hysterectomy is surgery to remove a woman's uterus. It may be done through an incision (cut) in either the abdomen (belly) or the vagina.

Alternative Names

Vaginal hysterectomy; Abdominal hysterectomy; Supracervical hysterectomy; Radical hysterectomy; Removal of the uterus; Laparoscopic hysterectomy; Laparoscopically assisted vaginal hysterectomy; LAVH; Total laparoscopic hysterectomy; TLH; Laparoscopic supracervical hysterectomy; Robotically assisted hysterectomy

Description

Your doctor will help you decide which type of hysterectomy is best for you. It will depend on your medical history and the reason for your surgery.

• Abdominal hysterectomy: The surgeon makes a 5-inch to 7-inch incision (cut) in the lower part of your belly. The cut may go either up and down, or it may go across your belly, just above your pubic hair (a bikini cut).
• Vaginal hysterectomy: The surgeon makes a cut in your vagina. Your uterus will be taken out through this cut. The cut in your vagina will be closed with stitches.
• Laparoscopic hysterectomy: A laparoscope is a narrow tube with a tiny camera on the end. Your surgeon will make 3 to 4 small cuts in your belly. The laparoscope and other surgical instruments will be inserted through the other cuts. Your uterus will be cut into smaller pieces that your surgeon will remove through the small cuts.
• Laparoscopically assisted vaginal hysterectomy: Your surgeon will remove your uterus through a cut inside your vagina. Your surgeon will also insert a laparoscope and other instruments into your belly through 2 or 3 small cuts.
• Robotic surgery is like laparoscopic surgery, but a special machine is used. It is most often used when a patient has cancer or is very overweight and vaginal surgery is not safe.

During a hysterectomy, the whole uterus or just part of it may be removed. The fallopian tubes (the tubes that connect the ovaries to the uterus) and ovaries may also be removed.

• A partial (or supracervical) hysterectomy is removal of just the upper part of the uterus. The cervix is left in place.
• A total hysterectomy is removal of the entire uterus and the cervix.
• A radical hysterectomy is the removal of the uterus, the tissue on both sides of the cervix (parametrium), and the upper part of the vagina. This is done mostly when some cancers are present.

Why the Procedure Is Performed

There are many reasons a woman may need a hysterectomy. But, there may be ways to treat your condition that do not require this major surgery. Your condition may be helped with less invasive surgery. Talk with your doctor about your treatment options.

After having their uterus removed, many women will notice changes both in their body and in how they feel about themselves. Talk with your doctor, your family, and your friends about these possible changes before you have surgery.

Hysterectomy may be recommended for:

• Tumors in the uterus, like uterine fibroids
• Cancer of the uterus, most often endometrial cancer
• Cancer of the cervix or a precancerous condition of the cervix called cervical dysplasia
• Cancer of the ovary
• Endometriosis, when your pain is severe and other treatments have not helped
• Severe, long-term (chronic) vaginal bleeding that cannot be controlled by medicines
• Prolapse of the uterus. A prolapsed uterus slips down into the vagina.
• Adenomyosis. This condition occurs when the tissue that lines the uterus grows inside the walls of the uterus.
• Chronic pelvic pain
• Complications during childbirth, like bleeding that cannot be controlled

Depending on the condition, other, less invasive treatments may be possible. See also:

• Uterine artery embolization
• Pelvic laparoscopy

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

Risks that are possible from a hysterectomy are:

• Injury to nearby organs, including the bladder or blood vessels
• Injury to bowels
• Pain during sexual intercourse
• Early menopause, if the ovaries are removed also

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

During the days before the surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs like these.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your doctor or nurse for help quitting.

On the day of your surgery:

• You will usually be asked not to drink or eat anything for 8 hours before the surgery.
• Take your drugs your doctor told you to take with a small sip of water.

Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

The average hospital stay depends on the type of hysterectomy you had. Most women stay 2 to 3 days. When hysterectomy is done because of cancer, the hospital stay is often longer.

You will be given pain medicine after surgery through an IV (intravenous, through a vein) and pills. You may also have a catheter into your bladder for 1 to 2 days to pass urine. You will be asked to get up and move around as soon as possible. This will help keep blood clots from forming in your legs and will help you avoid other problems as you recover.

You will be asked to get up to use the bathroom as soon as you are able. You may return to a normal diet as soon as your bowels start working again.

Outlook (Prognosis)

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.

If your ovaries are also removed and you have not gone through menopause yet, this surgery will cause menopause. Your doctor may recommend estrogen replacement therapy.

Some women worry that their sexual function will decrease after their uterus is removed. Sexual function after a hysterectomy depends mostly on what sexual function was like before the surgery.

References

Bulun SE. Endometriosis. N Engl J Med. 2009 Jan 15;360(3):268-79.

Van Voorhis B. A 41-year-old woman with menorrhagia, anemia, and fibroids: review of treatment of uterine fibroids. JAMA. 2009 Jan 7;301(1):82-93. Epub 2008 Dec 2.

American College of Obstetricians and Gynecologists. ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas. Obstet Gynecol. 2008 Aug;112(2 Pt 1):387-400.

Kaunitz AM, Meredith S, Inki P, Kubba A, Sanchez-Ramos L. Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis. Obstet Gynecol. 2009;113:1104-1116.

National Comprehensive Cancer Network. NCCN Practice Guidelines in Oncology: Cervical Cancer. v.1.2009

Answer 2

Definition

A hysterectomy is surgery to remove a woman's uterus, or womb. The womb is the area where a baby grows when a woman is pregnant.

Alternative Names

Vaginal hysterectomy; Abdominal hysterectomy; Supracervical hysterectomy; Radical hysterectomy; Removal of the uterus; Laparoscopic hysterectomy; Laparoscopically assisted vaginal hysterectomy; LAVH; Total laparoscopic hysterectomy; TLH; Laparoscopic supracervical hysterectomy; Robotically assisted hysterectomy

Description

During a hysterectomy, your doctor may remove the entire uterus or just part of it. The fallopian tubes (the tubes that connect the ovaries to the uterus) and ovaries may also be removed.

Types of hysterectomy:

• Partial (or supracervical) hysterectomy: The upper part of the uterus is removed. The cervix is left in place.
• Total hysterectomy: The entire uterus and cervix are removed.
• Radical hysterectomy: The uterus, upper part of the vagina, and tissue on both sides of the cervix are removed. This is most often done if you have cancer.

There are many different ways to perform a hysterectomy. It may be done through a surgical cut in either the belly (abdomen) or vagina.

Your doctor will help you decide which type of hysterectomy is best for you. The specific procedure depends on your medical history and reason for the surgery.

• Abdominal hysterectomy: The surgeon makes a 5- to 7-inch surgical cut in the lower part of your belly. The cut may go either up and down, or it may go across your belly, just above your pubic hair. This is called a "bikini cut."
• Vaginal hysterectomy: The surgeon makes a cut in your vagina and removes the uterus through this opening. The wound is be closed with stitches.
• Laparoscopic hysterectomy: A laparoscope is a narrow tube with a tiny camera on the end. Your surgeon will make 3 to 4 small cuts in your belly. The laparoscope and other surgical instruments will be inserted through the openings. The surgeon cuts the uterus into small pieces that can be removed through these openings.
• Laparoscopy-assisted vaginal hysterectomy: The surgeon removes the uterus through a cut that is made inside your vagina. A laparoscope is used to guide the procedure.
• Robotic hysterectomy: This procedure is like laparoscopic surgery, but a special machine (robot) is used. Robotic surgery is most often used to perform a hysterectomy when a patient has cancer or is very overweight and vaginal surgery is not safe.

Why the Procedure Is Performed

There are many reasons a woman may need a hysterectomy. The procedure may be recommended if you have:

• Cancer of the uterus, most often endometrial cancer
• Cancer of the cervix or a precancerous condition of the cervix called cervical dysplasia
• Cancer of the ovary
• Childbirth complications, such as uncontrolled bleeding
• Long-term (chronic) pelvic pain
• Severe endometriosis that does not get better with other treatments
• Severe, long-term vaginal bleeding that cannot be controlled by medicines or other surgeries
• Slipping of the uterus into the vagina (uterine prolapse)
• Tumors in the uterus, such as uterine fibroids
• Adenomyosis, which causes heavy, painful periods

Hysterectomy is a major surgery. It is possible that your condition may be treated without this major surgery. Talk with your doctor about all your treatment options. Less invasive procedures include:

• Uterine artery embolization
• Pelvic laparoscopy
• Endometrial ablation

Risks

The risks for any surgery are:

• Allergic reactions to medicines
• Breathing problems
• Blood clots, which may cause death if they travel to the lungs
• Bleeding
• Infection
• Injury to nearby body areas

Risks that are possible from a hysterectomy are:

• Injury to the bladder or ureters
• Pain during sexual intercourse
• Early menopause, if the ovaries are removed or if a woman is close to menopause
• Decreased interest in sex

Before the Procedure

Before deciding to have a hysterectomy, ask your doctor what to expect after the procedure. Many women who have had a hysterectomy notice changes in their body and in how they feel about themselves. Talk with your doctor, family, and friends about these possible changes before you have surgery.

Always tell your health care team about all the medicines you are taking, including herbs, supplements, and other medicines you bought without a prescription.

During the days before the surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs like these.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your doctor or nurse for help quitting.

On the day of your surgery:

• You will usually be asked not to drink or eat anything for 8 hours before the surgery.
• Take any medicines your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

After surgery, you will be given pain medicines to relieve any discomfort.

You may also have a tube, called a catheter, inserted into your bladder for 1 to 2 days to pass urine.

You will be asked to get up and move around as soon as possible after surgery. This helps prevent blood clots from forming in your legs and speeds up recovery.

You will be asked to get up to use the bathroom as soon as you are able. You may return to a normal diet as soon as you can without causing nausea or vomiting.

How long you stay in the hospital depends on the type of hysterectomy. If you have a robot-assisted hysterectomy, you will likely go home the next day. Other times, most women who have a hysterectomy stay in the hospital 2 to 3 days. The hospital stay may be longer if the hysterectomy is done because of cancer.

Outlook (Prognosis)

How long it takes you to recover depends on the type of hysterectomy. Recovery may take anywhere from 2 to 6 weeks. Average recovery times are:

• Abdominal hysterectomy: 4 - 6 weeks
• Vaginal hysterectomy: 3 - 4 weeks
• Robot-assisted hysterectomy: 2 - 4 weeks

A hysterectomy will cause menopause if you also have your ovaries removed. Removal of the ovaries can also lead to a decreased sex drive. Your doctor may recommend estrogen replacement therapy.

References

Entman SS, Graves CR, Jarnagin BK, Rao GG. Gynecologic surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 75.

Giudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010 Jun 24;362(25):2389-98.

Van Voorhis B. A 41-year-old woman with menorrhagia, anemia, and fibroids: review of treatment of uterine fibroids. JAMA. 2009 Jan 7;301(1):82-93.

National Comprehensive Cancer Network. NCCN Practice Guidelines in Oncology: Cervical cancer. v.1.2010

Middleton LJ, Champaneria R, Daniels JP, et al. Hysterectomy, endometrial destruction, and levonorgestrel releasing intrauterine system (Mirena) for heavy menstrual bleeding: systematic review and meta-analysis of data from individual patients. BMJ. 2010 Aug 16;341:c3929.

Reviewed By

Review Date: 02/28/2011

David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine.