A hysterectomy is a surgery that involves the removal of a woman’s uterus. It can ease symptoms such as severe pain and bleeding. If you have cancer, it can save your life. You will discuss what type of surgery you will have with your doctor. This will depend on your health issue. If you have any questions or concerns, let your doctor know.
Reaching the uterus
There are quite a few ways to reach the uterus to remove it. The best technique depends on the reason for your surgery. The three main approaches are described below:
• Vaginal: An incision or cut is made inside the vagina. The uterus is then taken out through this incision. This can be done if the uterus is not very large.
• Laparoscopic: A thin tube with a camera and a light on the end is used called a laparoscope. The doctor makes 2 to 4 small incisions in the abdomen. The tube is put through 1 of the incisions which sends live pictures to a video screen. This lets the doctor see inside the abdomen. Surgical tools are positioned through the other small incisions. The uterus can be removed from these incisions or through an incision made in the vagina. One of the following procedures can be done:
· The uterus is taken out through a small incision in the vagina. This is called “LAVH.”
· The uterus is taken out through the small incisions in the abdomen. The cervix is left in place. This is called “LSH.”
· The uterus and cervix are taken out through the small incisions in the abdomen. This is called “TLH.”
· During any of these procedures, robotic technique can be used. This helps the surgeon’s vision and hand movements.
· Abdominal. One incision of 4 to 6 inches is made in the abdomen and the uterus is taken out through this incision.
Types of Hysterectomy
When the uterus is taken out, the cervix may be left in place. Or it may also be taken out as well. If it’s removed, the top of the vagina is closed. In some cases, the ovaries and fallopian tubes are also removed.
• Removing the uterus.
During a total (simple) hysterectomy, the uterus and cervix are taken off. During a subtotal hysterectomy, just the uterus is removed. The cervix is left in place. This can also be called as supracervical hysterectomy. In either instance, the ovaries and fallopian tubes remain. If you have not yet gotten to menopause, the ovaries will keep producing hormones. You may still notice the changes of menstrual cycles. But you will not have periods and can’t get pregnant.
• Removing the uterus, ovaries, and tubes.
Along with the uterus, the ovaries and fallopian tubes may also be taken out. This is called a hysterectomy with salpingo-oophorectomy. It causes the body’s estrogen levels to drop rapidly. This is called “surgical” menopause. Women who have not reached menopause before surgery may have abrupt symptoms. But these symptoms can be treated, most commonly by estrogen replacement therapy.
Deciding on hysterectomy
You and your doctor can discuss the best options for you. As you decide, your doctor may ask you to think about the following:
• Is your health condition getting in the way of your daily life? Is the problem becoming worse? If not, might other treatments be tried first?
• Do you still intend to bear children? If so, other treatments should be considered.
• Should the fallopian tubes be taken out too? This will lower the chances of ovarian cancer since we now know that most ovarian cancers actually come from the tubes.
• Should the ovaries be removed too? This is normally done to treat or avert cancer. If removal is needed, talk to your doctor about estrogen replacement therapy.
Risks and possible complications of a hysterectomy may include
• Side effects from the anesthesia
• Bleeding, with a possible need for transfusion
• Damage to surrounding organs (bladder, bowel, ureters, nearby nerves or blood vessels)
• Blood clots in the legs or lungs
• Formation of scar tissue that may lead to pain or bowel obstruction in the future. This is very common with the abdominal approach.
• Need for second surgery
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