posted 24th August 2022
Hysterectomy
The uterus is removed during a hysterectomy. There are numerous reasons why this procedure may be necessary.
- Abnormal bleeding
- Fibroids
- Prolapse
- Cancer of the uterus, ovaries or cervix
- Endometrioses
- Chronic Pelvic Pain
- Adenomyosis
When it comes to noncancerous reasons, hysterectomy is usually only considered after all other therapeutic interventions have been attempted and failed.
Types of Hysterectomy
A supracervical or subtotal hysterectomy
The surgeon removes only the top portion of the uterus when performing this treatment, leaving the cervix in its original position. This would require you to continue with your smears.
A total hysterectomy
The surgeon completely removes the uterus and cervix.
A radical hysterectomy
The surgeon removes the entire uterus and tissue on the sides of the uterus, the cervix, and the upper portion of the vagina. Radical hysterectomy is often reserved for malignancy. The surgeon may remove the ovaries in operation known as oophorectomy, or they may be left in place by the surgeon. Salpingectomy is the term used to describe the surgery of removing the tubes. Hysterectomy and bilateral salpingectomy-oophorectomy are the terms used to describe the removal of the complete uterus, including both tubes and ovaries.
Should the tubes be removed?
Yes. Fallopian tubes are now know to be the cause of ovarian cancer in up to 70% of cases. In all cases of hysterectomy the tubes should be therefore removed. It also prevents other problems like pain, swollen tubes ( hydrosalpinx) etc occurring in future which might require further intervention. When the ovaries are removed, tubes will be removed along with the ovaries.
Routes of Hysterectomy
Most hysterectomies are carried out using minimally invasive techniques like laparoscopy, vaginal or VNOTE. In some cases, an open or bikini line incision would be required, especially if the uterus is large.
Laparoscopic hysterectomy
(see PDF)
This involves 3-4 small cuts of around 1cm on your tummy and the procedure is carried out using key hole instruments. There will also be scar at the top of the vagina. Usually you will be able to go home the next day.
Vaginal hysterectomy
(see PDF)
The entire hysterectomy is performed vaginally so there will not be any scar in your tummy. There are some limitations to doing vaginal hysterectomies as your ovaries/ tubes may not always be accessible and you might require a laparoscopy as well to help removed the tubes and /or ovaries. This is called laparoscopic assisted vaginal hysterectomy.
V NOTE hysterectomy
(see PDF)
This is a relatively new procedure which is essentially vaginal hysterectomy performed using key hole instruments. The advantage is less pain, better recovery, no abdominal scars and easy access to tubes and ovaries. The route of hysterectomy will be discussed with you as certain routes are not possible in certain situations.