A hysterectomy is an operation to remove the uterus and usually the cervix. Common reasons to perform a hysterectomy include painful or heavy periods (not responding to medical therapy), pelvic pain, fibroids or certain types of cancerous or pre-cancerous lesions.
A total hysterectomy means that both the uterus and the cervix are removed, whereas a sub-total hysterectomy means that only the uterus will be removed, and the cervix will remain. Please note that removal of the ovaries is not standard practice during a hysterectomy and therefore the patient will generally not need hormone replacement afterwards.
There are three ways to remove the uterus:
- Vaginal hysterectomy:
The complete procedure is performed via the vagina with no incisions in the abdomen.
- Laparoscopic hysterectomy:
Key-hole surgery where four small incisions (ranging between 5 & 10 mm) are made into the abdomen and the uterus removed through the vagina.
- Abdominal hysterectomy:
The uterus is removed through a large cut in the lower abdomen, about 15 – 20 cm in length and runs usually along the bikini line.
Over the last couple of years, more and more hysterectomies are being performed through the laparoscopic route. Advantages of laparoscopy versus other forms of surgery include:
- Lower risk for bleeding
- Less post-operative pain
- Shorter hospital stays
- Faster recovery
- Less wound infection
- Lower risk of wound dehiscence
- Low risk of abdominal hernia formation
- Lower risk of post-operative adhesions
- Lower risk for post-operative vaginal (vault) prolapse
A laparoscopic hysterectomy is performed via a camera as is shown in the above picture. There is no other route of surgery that can give the same kind of visualization as is found with a laparoscopic procedure. (Please see the picture below to get a better idea). It is as if you place the surgeons’ eye at the tip of the camera lens right at the site where the operation is being performed.
The optimal picture is because of increased magnification by the camera lens as well as the superb illumination supplied by the Xenon white light shining through the lens. This enables the surgeon to perform more precise surgery compared to any other route.
You can expect to remain in hospital for the first night after your procedure and can generally be discharged on the first post-operative day. Sick leave is usually granted for about 2-3 weeks after this procedure compared to the 6 weeks after an abdominal hysterectomy.
If you’ve had a total hysterectomy, you don’t need to perform pap smear tests anymore (provided that you did regular testing before and all the results have been normal).