Narrator: During a hysterectomy, your surgeon will remove your uterus. The uterus is a muscular organ in your pelvis that holds a baby during pregnancy. The uterine lining, or endometrium, is what sheds each month during your menstrual cycle when you are not pregnant. Your doctor may recommend a hysterectomy if you have abnormal bleeding, chronic pelvic pain, cancer, or other conditions of the uterus not responding to treatment. The uterus can be removed in an abdominal, vaginal, or laparoscopic hysterectomy. In an abdominal hysterectomy, called a Total hysterectomy, your surgeon will make an incision in your pubic area and remove both the uterus and cervix. During a vaginal hysterectomy, your surgeon will make an incision inside your vagina or use a laparoscope to remove the uterus through the vagina. In a laparoscopic hysterectomy, your surgeon will make several small cuts in your abdomen and insert a thin, lighted camera to view your uterus on a video screen. Special surgical tools will divide your uterus into pieces and remove them through the incisions. After a hysterectomy, you will not be able to become pregnant, but you will still need to have regular pelvic exams and mammograms to monitor your health.
- How it’s performed – Hysterectomy
- Performing a hysterectomy
- Laparoscopic Hysterectomy
- What Is Hysterectomy?
- Actual Total Laparoscopic Hysterectomy Surgery
- Differences between an abdominal hysterectomy and laparoscopic hysterectomy:
- Your Body After a Hysterectomy
- Why a hysterectomy is done
- Types of hysterectomy
- How a hysterectomy is done
- Side effects
- Hysterectomy: Pros and Cons
How it’s performed
Performing a hysterectomy
There are 3 ways a hysterectomy can be performed.
- laparoscopic hysterectomy
- vaginal hysterectomy
- abdominal hysterectomy
Laparoscopic surgery is also known as keyhole surgery. It’s the preferred way to remove the organs and surrounding tissues of the reproductive system.
During the procedure, a small tube containing a telescope (laparoscope) and a tiny video camera will be inserted through a small cut (incision) in your tummy.
This allows the surgeon to see your internal organs. Instruments are then inserted through other small incisions in your abdomen or vagina to remove your womb, cervix and any other parts of your reproductive system.
Laparoscopic hysterectomies are usually carried out under general anaesthetic.
During a vaginal hysterectomy, the womb and cervix are removed through an incision that’s made in the top of the vagina.
Special surgical instruments are inserted into the vagina to detach the womb from the ligaments that hold it in place.
After the womb and cervix have been removed, the incision will be sewn up. The operation usually takes about an hour to complete.
A vaginal hysterectomy can either be carried out using:
- general anaesthetic – where you’ll be unconscious during the procedure
- local anaesthetic – where you’ll be awake, but will not feel any pain
- spinal anaesthetic – where you’ll be numb from the waist down
A vaginal hysterectomy is usually preferred over an abdominal hysterectomy as it’s less invasive and involves a shorter stay in hospital. The recovery time also tends to be quicker.
During an abdominal hysterectomy, an incision will be made in your tummy (abdomen). It’ll either be made horizontally along your bikini line, or vertically from your belly button to your bikini line.
A vertical incision will usually be used if there are large fibroids (non-cancerous growths) in your womb, or for some types of cancer.
After your womb has been removed, the incision is stitched up. The operation takes about an hour to perform and a general anaesthetic is used.
An abdominal hysterectomy may be recommended if your womb is enlarged by fibroids or pelvic tumours and it’s not possible to remove it through your vagina.
It may also be recommended if your ovaries need to be removed.
What Is Hysterectomy?
Hysterectomy is the surgical removal of part or the entire uterus. It is the second most common major surgery among women of child-bearing age. Hysterectomy may be done to treat conditions that affect the uterus. Some reasons a hysterectomy may be needed include:
- Uterine fibroids
- Pelvic support problems (such as uterine prolapse)
- Abnormal uterine bleeding
- Chronic pelvic pain
Laparoscopic hysterectomy (or minimally invasive hysterectomy) is done through small incisions in the abdomen. The uterus is removed in small pieces through these incisions. Laparoscopic hysterectomy has a shorter recovery time than abdominal or vaginal hysterectomy.
A hysterectomy does not include removal of the ovaries and fallopian tubes. When these organs are removed at the same time as the uterus and cervix, it is called a salpingo-oophorectomy.
Actual Total Laparoscopic Hysterectomy Surgery
This video shows a total laparoscopic hysterectomy surgery performed and narrated by Kurian Thott, MD. The 42 year old patient had an enlarged uterus, multiple fibroids, and heavy menstrual cycles. This video is of an actual surgery, viewer discretion is advised.
Differences between an abdominal hysterectomy and laparoscopic hysterectomy:
- A standard hysterectomy requires a 4-8″ incision in the abdomen, as opposed to only a 1/4 – 1/2″ incision for a laparoscopic hysterectomy.
- Recovery is faster with a laparoscopic hysterectomy – about half the time of an abdonimal hysterectomy
- Less blood less
- Less pain
Your Body After a Hysterectomy
The fifth surgical option is an abdominal hysterectomy, the traditional approach. This procedure is the most invasive surgery with the most noticeable scar. In this procedure, the uterus is removed through a large incision in the abdomen — a horizontal cut along the bikini line, or a vertical incision if required.
Over time, any scars from a hysterectomy will usually become lighter in color, but the skin will never look exactly the same. Some women, especially women of color, are prone to keloids, a thickening of the scar tissue, Dr. Bradley says.
2. How much pain should I expect after having a hysterectomy?
Pain also depends on the hysterectomy surgical option you undergo. Most women with a laparoscopic or vaginal hysterectomy experience pain for two to three weeks. Some women have less pain after laparoscopically assisted vaginal hysterectomy than they do after a basic vaginal hysterectomy, according to a research review that appeared in The Journal of Minimally Invasive Gynecology in 2013. With abdominal hysterectomy, pain may last for three to five weeks.
The amount of pain and scarring also depends on what exactly is removed during your hysterectomy, which should be based on your reason for having the procedure, the expertise of your surgeon, and the surgical equipment available. For instance, just your uterus may be removed or your cervix may be taken out as well. Or if you have cervical cancer, for example, you might need a radical hysterectomy, which also takes out tissue on either side of the cervix and the upper part of the vagina. Each of these procedures can have a different effect after surgery when it comes to how much pain you experience.
3. What is the risk for complications after a hysterectomy?
While most women don’t have health problems during or after the surgery, risks may include:
- Injury to nearby organs
- Anesthesia problems, such as breathing or heart problems
- Blood clots in the legs or lungs
- Heavy bleeding
- Early menopause, if the ovaries are removed
- Pain during sexual intercourse
Bradley urges women considering a hysterectomy to speak with their doctors about having the most minimally invasive procedure possible, especially those who aren’t at a healthy weight. Overweight women who have abdominal surgery for noncancerous conditions are at greater risk for bleeding and infection than women of normal weight, according to a study in the journal Human Reproduction in 2011. It was also found that underweight women had more complications with laparoscopic and abdominal surgery.
4. Should I expect menopausal symptoms after a hysterectomy?
Menopause occurs when the ovaries stop producing the hormones estrogen and progesterone, which regulate menstruation. Unless you have your ovaries removed during a hysterectomy due to a medical reason, you likely won’t enter early menopause. But while most women don’t experience early menopause after a hysterectomy, some women may, even if they keep one or both ovaries, according to a Duke University study published in the journal Obstetrics & Gynecology in December 2011. Researchers aren’t sure whether it’s the surgery itself or the underlying condition leading to a hysterectomy that brings on early menopause in some cases.
If your doctor feels you’re at risk for ovarian cancer, your ovaries may also be removed, Bradley says, although this isn’t common. And if your ovaries are removed and you were premenopausal, you will likely go into abrupt menopause. Hot flashes, night sweats, and other symptoms may result. Estrogen replacement therapy can help alleviate these hysterectomy-related issues, Bradley says. However, there’s some concern that taking estrogen could raise your breast cancer risk if you’re over 45.
5. Will I still enjoy sex after a hysterectomy?
Women often report better sex after a hysterectomy, Bradley says, because the procedure relieved pain or heavy bleeding, and because they don’t have to worry about a possible unwanted pregnancy anymore. Some women who also have their cervix removed, however, may experience a drop in testosterone and possible sexual dysfunction. Don’t hesitate to discuss the sexual side effects and risks with your doctor before moving forward with a hysterectomy.
Bradley encourages women to work with their doctors to avoid hysterectomy. But when all other treatment alternatives are exhausted, hysterectomy may help — many women are relieved to be out of pain, especially if they’re not concerned about fertility.
After a hysterectomy, you will have a brief recovery time in the hospital. Your recovery time at home — before you can get back to all your regular activities — will vary depending on the procedure you had.
Abdominal hysterectomy. Most women go home 2-3 days after this surgery, but complete recovery takes from six to eight weeks. During this time, you need to rest at home. You should not be doing housework until you talk with your doctor about restrictions. There should be no lifting for the first two weeks. Walking is encouraged, but not heavy lifting. After 6 weeks, you can get back to your regular activities, including having sex.
Vaginal or laparoscopic assisted vaginal hysterectomy (LAVH). A vaginal hysterectomy is less surgically invasive than an abdominal procedure, and recovery can be as short as two weeks. Most women come home the same day or the next. Walking is encouraged, but not heavy lifting. You will need to abstain from sex for at least 6 weeks.
Laparoscopic supracervical hysterectomy (LSH). This procedure is the least invasive and can have a recovery period as short as six days to two weeks. Walking is encouraged, but not heavy lifting.
Robotic hysterectomy. The surgeon’s movements are mimicked by robotic arms that make small incisions to remove the uterus. Most women come home the next day. If the cervix is removed, you will have the same restrictions as you would have for an LAVH.
Call your doctor if you have any of these symptoms with any type of hysterectomy:
- Fever or chills
- Heavy bleeding or unusual vaginal discharge
- Severe pain
- Redness or discharge from incisions
- Problems urinating or having a bowel movement
- Shortness of breath or chest pain
A hysterectomy is surgery to remove the uterus. Other organs such as the cervix, ovaries, fallopian tubes, lymph nodes and parts of the vagina may also be removed at the same time.
Why a hysterectomy is done
A hysterectomy may be done to:
- treat cancers of the female reproductive organs
- treat precancerous conditions of the cervix that have not gone away after other types of treatment
- stage cancers of the female reproductive organs to find out how far cancer has spread
- treat non-cancerous conditions of the female reproductive organs that have not responded well to other types of treatment
Types of hysterectomy
There are different types of hysterectomy. The type recommended to you as part of your cancer treatment depends on the type and size of the tumour, the stage of the cancer, your age, other treatments you’ve had and your overall health.
A total hysterectomy removes the uterus and the cervix. A total hysterectomy is also called a simple hysterectomy.
A subtotal hysterectomy removes the uterus but leaves the cervix in place.
A radical hysterectomy removes the uterus, cervix, the uppermost part of the vagina next to the cervix and the nearby ligaments that support the uterus. Nearby lymph nodes in the pelvis are often removed at the same time as part of the staging operation.
Removing the ovaries and fallopian tubes
Sometimes one or both of the ovaries and fallopian tubes are removed at the same time as a hysterectomy. The removal of the ovaries and fallopian tubes is called a salpingo-oophorectomy. A bilateral salpingo-oophorectomy (BSO) removes both ovaries and fallopian tubes. A unilateral salpingo-oophorectomy removes one ovary and one fallopian tube.
A salpingo-oophorectomy is used to treat ovarian and fallopian tube cancers and is part of a staging operation for uterine cancers.
How a hysterectomy is done
A hysterectomy is most often done in the hospital using a general anesthetic (you will be unconscious) or a spinal or epidural anesthetic (you will be awake but not able to feel the surgery). You will stay in the hospital for a few days after any type of hysterectomy. Your doctor may prescribe pain medicine and antibiotics to prevent infection.
A hysterectomy can be done using different incisions (surgical cuts):
An abdominal hysterectomy is done through a large incision in the abdomen.
A laparoscopic hysterectomy is done by laparoscopy. Laparoscopic surgery uses a thin, tube-like instrument with a light and lens (called a laparoscope). It allows the surgeon to see the organs to be removed. The laparoscope and surgical tools to remove tissue are passed through small incisions in the abdomen. The uterus is commonly removed through the vagina.
Robotic surgery can also be used to remove the uterus. It is also done by laparoscopy, but the surgeon sits at a station a short distance away from the operating table and uses a computer to move robotic arms that are connected to surgical instruments.
A vaginal hysterectomy is done through small incisions in the upper part of the vagina. The uterus is removed through the vagina. A vaginal hysterectomy may be used to treat early stage cancers of the cervix and uterus.
Women who have a vaginal hysterectomy or a laparoscopic hysterectomy generally recover more quickly and get back to their regular activities sooner than women who have an abdominal hysterectomy. Complete recovery from an abdominal hysterectomy will take 6 to 8 weeks.
To help you recover from surgery, get plenty of rest for the first 2 to 4 weeks after surgery and don’t do any heavy lifting of more than 20 pounds during the first 4 to 6 weeks after surgery.
Check with your doctor about when it’s safe for you to increase your level of activity and when you can go back to work. Your doctor will also let you know when it is safe for you to drive, do heavy or strenuous exercise, start taking baths again and have sexual intercourse.
Side effects can occur with any type of treatment, but not everyone has them or experiences them in the same way. Side effects of surgery will depend mainly on the type of hysterectomy you have and your overall health.
Short-term side effects can happen during, immediately after or a few weeks after a hysterectomy. They are usually temporary. Short-term side effects of hysterectomy include:
- bladder problems
- blood clots in the legs or in the lungs
Short-term bladder problems may include losing the feeling of having to urinate or not being able to empty the bladder completely. Some women also may develop long-term bladder problems.
Long-term side effects can develop months or years after having a hysterectomy and can last a long time. If you have a hysterectomy, you will be infertile (not able to become pregnant) because your uterus has been removed. You may also experience:
- a buildup of lymph fluid in the legs or abdomen if lymph nodes in the pelvis are removed (called lymphedema)
- weakness of the muscles and ligaments that support the vagina, bladder and rectum
- vaginal shortening (may occur after a radical hysterectomy)
- blockage of the intestine caused by bands of scar tissue (called adhesions)
- treatment-induced menopause in premenopausal women, if the ovaries have been removed
Find out more about sexuality and cancer, sexual problems for women and treatment-induced menopause.
Hysterectomy: Pros and Cons
What is a hysterectomy?
A hysterectomy is an operation to remove the uterus. The ovaries and other reproductive organs may be left intact, but in some cases are taken out as well.
Each year US doctors perform about 600,000 hysterectomies. Indeed, after cesarean section, hysterectomy is the most commonly performed major operation on women in the country. Some of these operations are necessary to stop the growth of cancers of the uterus, ovaries, or cervix (if it’s advanced). The majority of hysterectomies, however, are done to treat noncancerous conditions such as uterine fibroids, endometriosis, and uterine prolapse. Yet many of these problems may be alleviated using less invasive methods.
Doctors used to view the uterus as largely expendable once a woman was past the childbearing years; the uterus was sometimes removed during fibroid surgery simply to eliminate the possibility of uterine cancer. But this attitude is rapidly changing. Today many doctors realize the uterus appears to play a role in regulating hormones, and don’t advise removing it unless it’s completely necessary.
Why are hysterectomies controversial?
Critics contend that in the past some doctors, with the goal of preventing uterine cancer, have prescribed hysterectomies to women who didn’t need them. In very rare cases, doctors have been charged with using hysterectomies as a form of birth control or involuntary sterilization, especially for women of color. There have also been cases where hysterectomies were performed without the knowledge or consent of the patient.
For many women, the biggest drawback to a hysterectomy is loss of fertility. Once you have a hysterectomy, you cannot conceive, and for many women of childbearing age, this is a significant loss. Women who feel pushed into a hysterectomy may also have a negative reaction to it.
When should I get a hysterectomy?
If you have cancer of the uterus or the ovaries or advanced cancer of the cervix, the surgery could save your life. In these cases, a hysterectomy, possibly including oophorectomy (removal of one or both ovaries), can banish the cancer and may prevent the spread of cancerous cells. Hysterectomy is also sometimes the only option for women with very large uterine fibroids or ovarian cysts, advanced pelvic inflammatory disease, or severe complications during pregnancy. Cesarean hysterectomy may be performed after delivery to stop life-threatening bleeding from the uterus.
If you have already had children or don’t want to have children, it may make sense to have a hysterectomy for a less serious condition if other approaches have failed — if, say, you’ve suffered fibroid pain and excessive bleeding that don’t respond to drugs or other treatments. In such circumstances, some women report that the operation has freed them from years of misery.
Are there alternatives to hysterectomy?
For some of the problems for which hysterectomy is prescribed, other approaches might suit you better. In the early stages of cancer of the cervix, ovaries, or uterus, a hysterectomy may not be necessary. And for conditions such as uterine fibroids, which are not life-threatening, you can consider a wealth of alternatives, including drug therapy and less invasive surgeries. Conditions that don’t usually require hysterectomy include:
- Abnormal menstrual bleeding
- Uterine fibroids (unless fibroids are causing such severe chronic and acute bleeding that the resultant anemia is life-threatening)
- Dropped uterus (uterine prolapse)
- Precancerous cervical lesions
- Chronic pelvic pain
Always get a second opinion if your doctor recommends a hysterectomy. Unless you have a life-threatening condition or you’re sure that a hysterectomy is the right choice, you may want to explore other options.
How do I prepare for the surgery?
If you’re having general anesthesia, you must not eat on the day of the surgery and should have only a light meal the night before. If you’re getting a local anesthetic, you can eat normally. If you have mixed feelings about having a hysterectomy but you’ve decided to go ahead because your condition is serious, you may want to prepare yourself emotionally by reading up on the operation (see Resources ). You may also want to find a local or online support group or just talk to some good friends about your feelings.
What happens after the operation?
You’ll stay in the hospital for a few days, then be told to rest at home for a number of weeks — usually at least a month. While in the hospital, you’ll probably be hooked up to an IV and, to empty your bladder, a catheter. Women who have abdominal hysterectomies generally need to stay in the hospital a day or two longer than women who have vaginal hysterectomies. (Vaginal hysterectomies don’t require opening the abdomen, so gastrointestinal function returns in a rapid fashion. Patients, in fact, can usually eat the day of surgery after a vaginal hysterectomy.)
For the first few weeks of your recovery, you will likely need to avoid lifting heavy objects as well as strenuous exercise. Your doctor may also recommend that you abstain from sexual intercourse during this time.
What are the side effects of a hysterectomy?
Some studies have shown that a decrease in sexual response or libido following the operation. A recent study, however, found no real difference in women’s sexual response before and after a hysterectomy. Some women even reported an improvement! Of course it’s not terribly surprising that women who’ve long endured excessive bleeding and pain during intercourse as a result of fibroids would indeed have a better sex life after the operation.
Since the nerves to the bladder pass near the uterus and may be damaged during a hysterectomy, women who’ve had the surgery are at somewhat higher risk for developing stress incontinence (some urine is released when exercise, sexual activity, sneezing, or coughing puts pressure on the abdomen). This can usually be resolved through regular practice of Kegel exercises, simple pelvic muscle exercises that can be done at home or even driving a car.
What resources are available?
For help in dealing with any difficult emotional, sexual, physical, or psychological effects of your hysterectomy, you might consider joining a support group. Other women who’ve gone through the procedure may offer valuable advice as well as comfort.
Myths, Lies, and Hysterectomy. Dr. Oz blog, 2017. http://blog.doctoroz.com/oz-experts/myths-lies-and-hysterectomy
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Mayo Clinic. Hysterectomy: Benefits and alternatives..
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Centers for Disease Control. Women’s Reproductive Health: Hysterectomy.