Hysterectomy: Purpose, Procedure, Risks, Recovery

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A hysterectomy is an operation to remove a woman's uterus. A woman may have a hysterectomy for different reasons, including:

Hysterectomy for noncancerous reasons is usually considered only after all other treatment approaches have been tried without success.

Depending on the reason for the hysterectomy, a surgeon may choose to remove all or only part of the uterus. Patients and health care providers sometimes use these terms inexactly, so it is important to clarify if the cervix and/or ovaries are removed:

The ovaries may also be removed -- a procedure called oophorectomy -- or may be left in place. When the tubes are removed that procedure is called salpingectomy. So, when the entire uterus, both tubes, and both ovaries are removed, the entire procedure is called a hysterectomy and bilateral salpingectomy-oophorectomy.

Surgeons use different approaches for hysterectomy, depending on the surgeons experience, the reason for the hysterectomy, and a woman's overall health. The hysterectomy technique will partly determine healing time and the kind of scar, if any, that remains after the operation.

There are two approaches to surgery - a traditional or open surgery and surgery using a minimally invasive procedure or MIP.

An abdominal hysterectomy is an open surgery. This is the most common approach to hysterectomy, accounting for about 65% of all procedures.

To perform an abdominal hysterectomy, a surgeon makes a 5- to 7-inch incision, either up-and-down or side-to-side, across the belly. The surgeon then removes the uterus through this incision.

Following an abdominal hysterectomy, a woman will usually spend 2-3 days in the hospital. There is also, after healing, a visible scar at the location of the incision.

There are several approaches that can be used for an MIP hysterectomy:

Using an MIP approach to remove the uterus offers a number of benefits when compared to the more traditional open surgery used for an abdominal hysterectomy. In general, an MIP allows for faster recovery, shorter hospital stays, less pain and scarring, and a lower chance of infection than does an abdominal hysterectomy.

With an MIP, women are generally able to resume their normal activity within an average of three to four weeks, compared to four to six weeks for an abdominal hysterectomy. And the costs associated with an MIP are considerably lower than the costs associated with open surgery, depending on the instruments used and the time spent in the operating room. Robotic procedures, however, can be much more expensive. There is also less risk of incisional hernias with an MIP.

Not every woman is a good candidate for a minimally invasive procedure. The presence of scar tissue from previous surgeries, obesity, and health status can all affect whether or not an MIP is advisable. You should talk with your doctor about whether you might be a candidate for an MIP.

Most women who undergo hysterectomy have no serious problems or complications from the surgery. However, hysterectomy is considered a major surgery and is not without risks. Those complications include:

Other risks from hysterectomy include wound infections, blood clots, hemorrhage, and injury to surrounding organs, although these are uncommon.

After a hysterectomy, if the ovaries were also removed, a woman will enter menopause. If the ovaries were not removed, a woman may enter menopause at an earlier age than she would have otherwise.

Most women are told to abstain from sex and avoid lifting heavy objects for six weeks after hysterectomy.

After a hysterectomy, the vast majority of women surveyed feel the operation was successful at improving or curing their main problem (for example, pain or heavy periods).

SOURCES:

Katz, V. Comprehensive Gynecology, Fifth Edition, Mosby Elsevier, 2007.

Ethicon Endo-Surgery: "Open Surgery vs MIP for Hysterectomy"and "Risks and Complications."

Jewish Hospital & St. Mary's HealthCare: "Minimally Invasive Hysterectomies."

Medical News Today: "New Studies Demonstrate Benefits Of Minimally Invasive Hysterectomy And Colectomy When Compared To Open Surgery."

The American College of Obstetricians and Gynecologists. Single-Incision Laparoscopy. Technology Assessment, August 2013.

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Hysterectomy: Purpose, Procedure, Risks, Recovery

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