Hysterectomy

A hysterectomy (fallopian tube removal) is a surgical procedure during which the uterus (womb) is removed. It is performed for uterine fibroids (benign growths of the uterus), abnormal uterine bleeding, endometriosis and uterine prolapse. Sometimes it is performed to treat uterine cancer or very severe pre-cancers (called dysplasia, carcinoma in situ, or CIN III, or micro invasive carcinoma of the cervix).

Sometimes it is performed to treat uterine cancer or very severe pre-cancers (called dysplasia, carcinoma in situ, or CIN III, or micro-invasive carcinoma of the cervix).

A hysterectomy for endometrial cancer (uterine lining cancer) has an obvious purpose, that of removal of cancer from the body and it is the foundation of treatment for cancer of the uterus.

Prior to a hysterectomy, a woman must have a pelvic examination, Pap smear, ultrasound and complete blood count.

In the past, hysterectomy was most commonly done by an incision (cut) through the abdomen (abdominal hysterectomy) and now it is done laparoscopically or vaginally. The procedure takes about two hours.

Hysterectomy can be performed using a variety of surgical techniques. It depends on a woman’s particular medical condition.

1. Total abdominal hysterectomy is the most common type of hysterectomy during which the doctor removes the uterus, including the cervix. The scar is horizontal or vertical, depending on the reason the procedure is performed, and the size of the area being treated. It is used to treat cancer of the ovary(s) and uterus, endometriosis, and large uterine fibroids and if it is not a serious condition, it is not performed on women of childbearing age.
2. Vaginal hysterectomy is only for conditions such as uterine prolapse, endometrial hyperplasia, or cervical dysplasia and the uterus is removed through the vagina. In women who have not had children, the vaginal canal may not be large enough and in women who cannot have her legs raised in the stirrup device for prolonged periods, or has other reasons why the whole upper abdomen must be further examined, the doctor will usually recommend an abdominal hysterectomy.
3. Laparoscopy-assisted vaginal hysterectomy (LAVH) is similar to the vaginal hysterectomy procedure described above, but also with use of laparoscope (a very thin viewing tube with a magnifying glass-like device at the end of it). It is a more expensive procedure than vaginal or abdominal hysterectomy, more prone to complications, requires longer to perform, is associated with longer hospital stays and the uterus must not be excessively large, just as with simple vaginal hysterectomy.
4. The laparoscopic supra cervical hysterectomy procedure is performed like the LAVH procedure, the only cautery is used to cut the cervix off at the cervical stump and the tissue is all removed through a laparoscopic tool.
5. A supracervical hysterectomy is used to remove the uterus while sparing the cervix, leaving it as a "stump" so women who have had abnormal Pap smears or cervical cancer are not appropriate candidates for this procedure because the possibility of developing cancer in this remnant "stump". It is a simple procedure, requires less time to perform and it may give some added support of the vagina, decreasing the risk for the development of protrusion of the vaginal contents through the vaginal opening (vaginal prolapse).
6. The radical hysterectomy is a more extensive surgery than a total abdominal hysterectomy because it also includes removing tissues surrounding the uterus and removal of the upper vagina so it has more complications which can include injury to the bowels and urinary system. It is usually performed for early cervical cancer.
7. Oophorectomy is the surgical removal of the ovary(s) and salpingo-oophorectomy is the removal of the ovary and its adjacent Fallopian tube. They are performed for ovarian cancer, removal of suspicious ovarian tumors, or Fallopian tube cancer (which is very rare) and also due to complications of infection, or in combination with hysterectomy for cancer.

Complications of a hysterectomy include infection, pain, and bleeding in the surgical area.

After a hysterectomy, women with a history of abnormal Pap smears is recommended to have Pap smears for the remainder of her life and women who have had vaginal hysterectomy or abdominal hysterectomy for benign (not cancer) reasons, such as uterine fibroids with normal Pap smears prior to the procedure do not need to continue having Pap smears.