What is a Hysterectomy?
Hysterectomy is a surgical procedure to remove a woman’s uterus. It is a very common treatment for women with severe uterine health problems. Often (far too often, if you ask me) this procedure is done as a “traditional open surgery” with a hospital admission with a multi-day hospital recovery and a large incision and a recovery that can last a couple of months.
This is not how a hysterectomy needs to be performed these days, it should be a minimally invasive procedure where the patient goes home the very same day and is recovered in a couple of weeks.
Unfortunately, there are too few surgeons that perform this surgery laparoscopically on an outpatient basis. I do over 99% of mine this way. For more information about our advanced outpatient surgical procedures, please visit our Outpatient Hysterectomy Center website.
When is a hysterectomy the best option?
Many women choose a hysterectomy after they have exhausted all other treatment options, or will wait to have a hysterectomy until they are finished having children, which is not an uncommon practice. Following hysterectomy surgery, a woman is no longer able to become pregnant.
Some women with a family history of some cancers may choose this procedure to help reduce the chances of such problems as they age.
In the following videos, Dr. Aliabadi performs outpatient hysterectomy on Sheila, who was suffering from fibroids. Watch Sheila’s story and her amazing recovery.
Some conditions that may be treated with a hysterectomy include:
Cancer of the uterus or other nearby reproductive organs
Abnormal uterine bleeding
Elective hysterectomy surgery
Some women may choose to have elective surgery to remove their uterus, ovaries, and/or fallopian tubes if they are at high risk for cancer. If you have a strong family history of cancer, or you are a member of another high-risk group, talk with your gynecologist about elective risk-reduction surgery.
What is removed during a hysterectomy surgery?
There are three primary types of hysterectomy, categorized by the amount of tissue that is removed.
Total abdominal hysterectomy
This is the removal of the uterus and the cervix through an incision in the abdomen.
Also called a partial hysterectomy, this is the removal of the uterus only. The cervix is left intact. A supracervical hysterectomy may be performed through abdominal surgery or laparoscopic surgery.
In this procedure, the uterus and cervix are removed, as well as some surrounding tissue, such as the ovaries (oophorectomy) or fallopian tubes (salpingectomy). Your doctor may recommend this procedure if you have gynecologic cancer, or if your pelvic organs are affected by endometriosis.
Methods used to perform a hysterectomy?There are a few common methods used to perform a hysterectomy. The method your doctor will recommend will depend on your medical history, your age, your general health, and how much tissue is to be removed. It’s possible that the surgeon may begin the hysterectomy with one method, but then change methods if they find other existing complications.
This is the most common type of hysterectomy surgery. This is an “open surgery” that requires hospital admission and several days of inpatient recovery. As I mentioned above, though is a common way to perform this procedure, it is almost always a far more invasive surgery than it needs to be.
How it is performed is the surgeon makes an incision in the lower abdomen, underneath your navel, to expose the pelvic organs. The tissue is then removed through the incision. Abdominal surgery is traditionally recommended for women with large uteruses or have pelvic scar tissue from damage or disease, such as adhesions. This type of surgery carries some risk of complications, including bleeding, tissue damage, and infections.
As I said earlier, virtually all of my hysterectomies are performed laparoscopically on an outpatient basis. Here I make a few tiny incisions in the patient’s abdomen and completes the surgery with the aid of a laparoscope – a narrow, flexible instrument with a lighted camera at the end.
Traditionally, the tissue is removed in small pieces through the incisions, but that is not how we perform the surgery. This is because there is a risk of spreading cells throughout the abdomen and not what we want in case there are any pre-cancerous cells in the tissue. It’s just not safe.
So what we do is wrap the tissue we are removing in a surgical bag which stops the existing tissue from contaminating any other tissue when it is being removed.
This type of surgery is also less painful than an abdominal hysterectomy and carries less risk of infection. Also, the recovery time is much quicker than open abdominal surgery, weeks instead of months.
Laparoscopic-assisted vaginal hysterectomy (LAVH)
This procedure removes the uterus through the vagina, with the assistance of a laparoscope inserted through small incisions in your abdomen. There are generally fewer risks with this type of surgery, and recovery time is much quicker than with abdominal methods. However, women who have very large uteruses or who have pelvic adhesions, may not be able to have this type of surgery.
This procedure is typically conducted laparoscopically with the aid of a robotic surgical instrument that the surgeon controls. Though often touted as being state-of-the-art, it is often less precise and can have a less predictable outcome.
Depending on the type of surgery, you will need to stay in the hospital for a few days following the procedure. You will likely experience some pain, however, your doctor can help you manage this with medication.
As with most major surgeries, blood clotting is one possible complication. You will be asked to walk around after your surgery to facilitate circulation in your legs.
It’s normal to experience some mild to moderate vaginal bleeding and discharge following the surgery. Use sanitary pads instead of tampons. It might be difficult to have a bowel movement or completely empty your bladder for a few days after a hysterectomy.
For 6-8 weeks after your surgery, you should:
- Get plenty of rest
- Avoid heavy lifting
- Get some light exercise. Taking short walks every day will improve your circulation and help you regain your strength.
- Avoid vaginal intercourse
- Avoid inserting anything into your vagina, including douches and tampons
- Call your gynecologist if you experience any signs of infection, such as fever, chills, nausea, or vomiting