The hysterectomy is a surgical procedure to remove the uterus (womb). This is a common surgery in the United States and there are several reasons for performing a hysterectomy, including uterine fibroids, abnormal uterine bleeding, chronic pain, endometriosis, issues of pelvic support and even cancer. Once the uterus is removed, a patient is not able to become pregnant in the future.
Different Options for a Hysterectomy
The uterus and the cervix are part of the same organ. During a hysterectomy, the cervix may or may not be removed. The fallopian tubes and the ovaries are found on either side of the uterus. Depending on the problem leading to the surgery, these organs may be removed at the same time. This would be discussed between you and your doctor before the operation. If the ovaries are removed, your doctor will discuss menopause and the medication options for hormone support after the procedure.
Hysterectomies can be performed with an abdominal incision, vaginally, laparoscopically, or robotically. The approach would depend on the reasons for the surgery, the expertise of the provider, and the course of the operation. At times, the approach may need to change if unforeseen challenges are encountered during an operation.
The abdominal hysterectomy is performed through an abdominal incision. The vaginal hysterectomy is performed through a vaginal approach without an abdominal incision. The laparoscopy and robotic assisted hysterectomies are performed using several small abdominal incisions through which instruments are inserted into the abdomen. In the robotic assisted hysterectomy, the robotic machine is controlled by the surgeon.
Risks & Benefits of a Hysterectomy
Risks and benefits differ depending on the approach. Generally, all are safe procedures, and the risks are shared. These include the risk of bleeding, infection, and unexpected injury to organs near where the operation is taking place, such as the bladder or bowel. Individual patients may present with an enhanced risk of problems in surgery due to underlying medical conditions. A thorough discussion of all aspects of a patient’s history, medications, and other issues is elemental to careful planning of surgery.
Care After a Hysterectomy
A patient undergoing a hysterectomy may be able to go home after a brief recovery in the hospital or surgery center. This could occur later the same day or after several days, depending on the approach and type of hysterectomy. The goal is to ambulate (begin to move freely) and return to normal activity at the earliest safe timeframe.
In the initial recovery from surgery, pain control is essential. Return of normal bladder and bowel function is monitored carefully after surgery and progressive activity is tailored to the individual patient. Your doctor will discuss this with you and plan your unique needs following your operation.
After recovery from the hysterectomy, you should continue to see your doctor for routine gynecological care. Depending on the reason for your procedure, you may need to have follow-up pelvic examinations and cervical cancer screening. Your doctor will plan the follow-up care with you.