Hysterectomy
A surgical procedure involving removal of the uterus, a hysterectomy may be performed abdominally, vaginally, or through a laparoscope. In a laparoscopic hysterectomy, the surgeon uses the laparoscope to perform preparatory steps before removing
the uterus through the vagina. (See Advantages of laparoscopic hysterectomy.) Patients with menorrhagia (excessive menstrual bleeding) may be treated with microwave endometrial ablation, a less invasive treatment.
the uterus through the vagina. (See Advantages of laparoscopic hysterectomy.) Patients with menorrhagia (excessive menstrual bleeding) may be treated with microwave endometrial ablation, a less invasive treatment.
Advantages of laparoscopic hysterectomy
Although not appropriate for all patients, the laparoscopic approach to hysterectomy is gaining wide acceptance—especially as an alternative to abdominal hysterectomy. Technological advancements have made this approach a viable option.
Among the benefits of the laparoscopic approach are the avoidance of a large abdominal incision (used in traditional abdominal hysterectomy), reduced tissue trauma, fewer sutures required (reducing the chance of reaction to suture material), and dramatically improved postoperative recuperation. This results in shorter hospital stays, lower cost, and decreased pain and morbidity as compared with traditional hysterectomy procedures.
A hysterectomy may be classified as subtotal, total, panhysterectomy, or radical. Rarely performed today, a subtotal hysterectomy involves the removal of the entire uterus except the cervix. In a total hysterectomy, both the uterus and the cervix are removed. In a panhysterectomy, the entire uterus as well as the ovaries and the fallopian tubes are removed. In a radical hysterectomy, the uterus, ovaries, fallopian tubes, adjoining ligaments and lymph nodes, upper one–third of the vagina, and surrounding tissues are all removed. Because of the extensiveness of the procedure, a radical hysterectomy requires an abdominal approach.
Common indications for a hysterectomy include malignant or benign tumors in or on the uterus, cervix, or adnexa; uterine bleeding and hemorrhage; uterine rupture or perforation; life–threatening pelvic infection; endometriosis unresponsive to conservative treatment; and pelvic floor relaxation or prolapse.
Procedure
After the patient has received general anesthesia, the surgeon makes the incision. For an abdominal approach, the surgeon makes a midline vertical incision from the umbilicus to the symphysis pubis or a horizontal incision in the lower abdomen. He then excises and removes the uterus and necessary accompanying structures. Afterward, he closes the incision and applies a dressing and perineal pad.
For a vaginal approach, the surgeon makes an incision inside the vagina above, but near, the cervix. After excising the uterus, the surgeon removes it through the vaginal canal. He then closes the opening to the peritoneal cavity with sutures and applies a perineal pad.
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