Hysterectomy

What is a Hysterectomy?

A Hysterectomy involves the removal of the uterus (womb). The procedure is done in an operating theatre usually under a general anaesthetic.

Types of Hysterectomy

There are two types of hysterectomy:

• Total hysterectomy where the uterus and the cervix is removed
• Subtotal hysterectomy where the uterus is removed but the cervix is left behind

We recommend that the Fallopian(uterine) tubes are removed (Salpingectomy) at the time of hysterectomy where possible as it lowers the risk of ovarian cancer. Removing the tubes does not affect hormone levels. Sometimes the ovaries are also removed (oophorectomy) as it will reduce the risk of ovarian cancer.  We recommend oophorectomy for all women older than 60 and in younger women if there is an indication.

Vaginal Hysterectomy

With a vaginal hysterectomy the uterus is removed through the vagina so there are no incisions in the abdomen.  The cervix is always removed.  Recovery following vaginal hysterectomy is much faster than abdominal hysterectomy but not as fast as a laparoscopic hysterectomy. Patients are usually discharged from the hospital after two or three days.

Laparoscopic Hysterectomy

A small incision is made inside the umbilicus. The abdomen is inflated with CO2 -gas and a fibre-optic instrument, called a laparoscope, inserted to view the internal organs. Further two or three small incisions are made in your abdomen through which tiny surgical instruments are passed. The hysterectomy is done and the uterus (and cervix if a total hysterectomy is done) are removed (and the tubes and/or ovaries if needed) through the vagina. If a subtotal hysterectomy is done, a small incision will be made in the lower abdomen to remove the uterus. Patients are usually discharged the next day.

 Laparoscopic hysterectomy has benefits such as:

• Shorter recovery time
• Faster Return to Usual Activities
• Reduced Post Surgical Pain
• Minimal Scarring
• Less risk of adhesions compared with abdominal hysterectomy
  
  

Abdominal Hysterectomy

It is performed if the uterus is significantly enlarged or if there is gross pelvic pathology including adhesions. With an abdominal hysterectomy the surgeon has greater access to the pelvis. The uterus is removed through an incision into the lower abdominal wall. It can be made horizontally (a Pfannenstiel or bikini-cut) or vertically (in the midline).