If you have a gynaecologic cancer such as cancer of the uterus or cervix — a hysterectomy may be your best treatment option. Depending on specific cancer you have and how advanced it is, your other options might include radiation or chemotherapy.
A hysterectomy is the only certain, permanent solution for fibroids — benign uterine tumours that often cause persistent bleeding, anaemia, pelvic pain or bladder pressure. Nonsurgical treatments of fibroids are a possibility, depending on your discomfort level and tumour size. Many women with fibroids have minimal symptoms and require no treatment.
In endometriosis, the tissue lining the inside of your uterus (endometrium) grows outside the uterus on your ovaries, fallopian tubes, or other pelvic or abdominal organs. When medication or conservative surgery doesn't improve endometriosis, you might need a hysterectomy along with the removal of your ovaries and fallopian tubes (Bilateral Salpingo-Oophorectomy).
Descent of the uterus into your vagina can happen when supporting ligaments and tissues weaken. Uterine prolapse can lead to urinary incontinence, pelvic pressure or difficulty with bowel movements. A hysterectomy may be necessary to treat these conditions.
Abnormal Vaginal Bleeding
If your periods are heavy, irregular or prolonged each cycle, a hysterectomy may bring relief when the bleeding can't be controlled by other methods.
Chronic Pelvic Pain
Occasionally, surgery is a necessary last resort for women who experience chronic pelvic pain that clearly arises in the uterus. However, a hysterectomy provides no relief from many forms of pelvic pain, and an unnecessary hysterectomy may create new problems. Seek careful evaluation before proceeding with such major surgery.
Surgical Techniques for Hysterectomy
Surgeons use different approaches for hysterectomy, depending on the surgeon’s experience, the reason for the hysterectomy, and the patient'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.
Open Surgery Hysterectomy
An abdominal hysterectomy is an open surgery. This is the most common approach to hysterectomy, accounting for about 54% of all benign disease.
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 person 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 a MIP Hysterectomy:
The surgeon makes a cut in the vagina and removes the uterus through this incision. The incision is closed, leaving no visible scar.
This surgery is done using a laparoscope, which is a tube with a lighted camera, and surgical tools inserted through several small cuts made in the belly or, in the case of a single site laparoscopic procedure, one small cut made in the belly button. The surgeon performs the hysterectomy from outside the body, viewing the operation on a video screen.
Laparoscopic-assisted Vaginal Hysterectomy:
The surgeon uses laparoscopic tools in the belly to assist in the removal of the uterus through an incision in the vagina.
Robot-assisted Laparoscopic Hysterectomy:
This procedure is similar to a laparoscopic hysterectomy, but the surgeon controls a sophisticated robotic system of surgical tools from outside the body. Advanced technology allows the surgeon to use natural wrist movements and view the hysterectomy on a three-dimensional screen.
Comparison of MIP Hysterectomy & Abdominal 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, people are generally able to resume their normal activity within an average of 3-4 weeks, compared to 4-6 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 everyone is a good candidate for a minimally invasive procedure. The presence of scar tissue from previous surgeries, obesity, the size of the uterus, 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.
Risks of Hysterectomy
Most people who get a hysterectomy have no serious problems or complications from the surgery. Still, a hysterectomy is major surgery and is not without risks. Those complications include:
What to Expect After Hysterectomy
- Urinary incontinence
- Vaginal prolapse (part of the vagina coming out of the body)
- Vaginal fistula formation (an abnormal connection that forms between the vagina and bladder or rectum)
- Chronic pain
- Other risks from hysterectomy include wound infections, blood clots, haemorrhage, and injury to surrounding organs, although these are uncommon.
After a hysterectomy, if the ovaries were also removed, you'll be in menopause. If the ovaries were not removed, you may enter menopause at an earlier age than you would have otherwise.
Most people are told to abstain from sex and avoid lifting heavy objects for six weeks after hysterectomy.
After a hysterectomy, most people surveyed say they feel the operation succeeded at improving or curing their main problem (for example, pain or heavy periods).