What is Hysterectomy?
‘Hystero’ word comes from a Greek word Hystera which means uterus or womb. ‘Ectomy’ is the derived from another Greek word which means removal or cutting out. So, the word Hysterectomy means removal of the uterus.
The uterus has a body and a mouth called cervix. It is attached to fallopian tubes on both sides which connect it to the ovaries. So the tissues that can be removed in hysterectomy are uterus, cervix, fallopian tubes and ovaries.
Ovaries produce the female hormones estrogen and progesterone which serve many important functions like regulation the menstrual cycle, maintenance of good reproductive health, bone health and heart health in a female. Any hysterectomy in which ovaries are removed, will lead to sudden loss of female hormones and the female will enter menopause instantaneously with symptoms like hot flashes, depression, vaginal dryness, vaginal atrophy, night sweats, osteoporosis etc. This is also called surgical menopause. So your surgeon will always try to conserve your ovaries, whenever feasible.
Table of Contents
Why is hysterectomy done? – Hysterectomy indications?
Hysterectomy is a common procedure but it is a major surgery and involves removal of an organ from your body. So it is very important to understand the indications for which your uterus may need to be removed. Common indications for hysterectomy are as follows:
- Fibroids (Noncancerous tumors of uterus)
- Uterine or ovarian cancers
- Uterine prolapse: Uterus falling out of the vagina when the ligaments holding it become weak.
- Endometriosis
- Cervical polyps
- Endometrial polyps
- Dysfunctional uterine bleeding (DUB): DUB refers to erratic and heavy bleeding, which does not respond to optimal medical management.
- Uncontrolled bleeding after childbirth: Sometimes after vaginal delivery or C-section, there is very heavy bleeding which does not respond to any medical measures. In such cases, uterus is removed as a life saving procedure (Peripartum Hysterectomy).
- Any other gynecological or obstetric surgery involving uterus or cervix, in which bleeding becomes uncontrollable.
- Chronic cervical infection
- Severe infections of the uterus leading to pelvic inflammatory disease which is not responding to antibiotic therapy.
- In some cases, women may opt for this treatment to eliminate the risk of Cancer if they have a family history of presence of cancer genes like BRCA 1 or BRCA 2.
What are the types of hysterectomies?
Types of hysterectomy based on amount of tissue removed:
- Subtotal hysterectomy or Part hysterectomy: In this procedure, only the uterus is removed. The cervix, bilateral tubes and ovaries are conserved. It is also called Supra cervical hysterectomy. Cervix is the lower part of the uterus and a cancer called cervical cancer is known to develop in the cervix. So, it is important to remember that in subtotal hysterectomy, since the cervix is conserved, regular cervical cancer screening by PAP smear is mandatory even after the hysterectomy surgery.
- Total hysterectomy: In this procedure, the uterus along with cervix is removed but bilateral tubes and ovaries are conserved.
- Pan hysterectomy: In this procedure, the uterus, cervix, bilateral tubes and ovaries are all removed. This type of procedure is usually done when hysterectomy is being performed for an indication after menopause or there is a doubt of malignancy or there are some tumors in ovaries/tubes along with the uterus. it is also called Total hysterectomy with bilateral salpingo-oophorectomy.
- Radical hysterectomy: This type of surgery is done when there is cancer of the uterus, cervix, fallopian tubes or ovaries. In this surgery, uterus, cervix, bilateral tubes and ovaries are removed along with the supplying lymph nodes of the area to remove all the cancer cells which might have spread to these areas.
Types of hysterectomy based on the surgical technique used:
- Abdominal hysterectomy or Open hysterectomy: In this method, an incision is given in the lower part of your abdomen. Uterus is cut out and brought out through this incision.
- Laparoscopic Hysterectomy or Lap Hysterectomy: This is a minimally invasive technique in which the uterus is removed with the help of a camera and some instruments inserted via tiny holes into the abdomen. Uterus is cut out, without opening the abdomen and is delivered out through the vagina like a baby. Laparoscopic Hysterectomy has the advantage of lesser pain, lesser blood loss, lesser tissue trauma, lesser risk of infection, quicker mobility and minimal scarring as compared to Abdominal hysterectomy. The incisions are smaller and healing is faster. However, with modern equipment and expertise, the recovery has now become comparable with both laparoscopic and open techniques of hysterectomy.
- Vaginal hysterectomy: In this method, the uterus is cut and delivered out through the vaginal route, without any incision on the abdomen. This is a preferred surgical method in cases where the uterus has partially or completely descended into the vagina due to weakness of ligaments that hold the uterus inside the pelvis.
- Laparoscopic assisted vaginal hysterectomy (LAVH): With the advent of laparoscopic surgeries, vaginal hysterectomy can be performed in cases without any vaginal descent and has been converted into laparoscopic assisted vaginal hysterectomy(LAVH). The uterus is partially dissected through a laparoscope and instruments inserted via tiny holes in the abdomen so as to free it from the ligaments and then the rest of the surgery is done through vaginal route.
- Robotic hysterectomy: This method of surgery is similar to the laparoscopic approach. It is just that a robot or a machine is the operative surgeon and the actual surgeon sits and operates the robot.
How is hysterectomy done?
Hysterectomy procedure: As we have seen above, there are many types of hysterectomy procedures, based on the amount of tissue to be removed and the approach used for hysterectomy. This has to be individualized for every patient, depending on the indication for hysterectomy, surgical options, choice of the surgeon and finally the patient choice, from the available options.
Your gynecologist will explain you in detail about the type of hysterectomy needed in your case and options available for performing the hysterectomy. You will also be examined by an anesthesiologist to determine your fitness for surgery and to decide the best form of anesthesia for your surgery. During your discussion with your gynecologist, you can indicate your preference of surgical approach and the type of anesthesia. Your gynaecologist will try to accommodate your choices, if feasible and a final plan for the procedure will be discussed with you.
You will be scheduled for surgery on a particular date. Your doctor will prescribe you certain pre-medications, to be taken on your own a day before. You should preferably take lighter meals one day prior to surgery and empty your bowel well on the day of the surgery. In case you have slow intestine or constipation, you can request your gynecologist to prescribe you a laxative. You should have your last meal approximately 8 to 10 hours before the surgery. That means that you do not consume any liquids or solids in that window.
Once in the hospital, you will be changed into a patient gown and given a cap to wear. An IV line will be started in the preoperative holding area and certain premedications will be administered through that line. After the initial preparation, you will be taken to the OT where an anesthetist will guide you regarding your anesthesia. Once you are administered the anesthesia, your surgery begins. After completion of your surgery, you will be taken out of anesthesia and shifted to recovery room for observation.
With today’s refined surgical and anesthetic techniques and the armamentarium of pain killers, surgeries have become extremely comfortable and pain free. Even after surgery, pain killers are continuously given through intravenous route or epidural route which keep you comfortable in your postoperative period.
Types of anesthesia for hysterectomy? Is it necessary that I will be given an injection in my back for removal of my uterus?
Depending on the type of hysterectomy planned, your anesthetist will decide the type of anesthesia to be given to you. The types of anesthesia that you may be given are:
Types of anesthesia for hysterectomy:
- Spinal anesthesia/Epidural anesthesia: This type of anesthesia is also called Regional Anesthesia. In this, an injection is given in your back and drugs are given through that injection which block all the nerves below your ribcage. It is the most commonly performed anesthesia for any surgery below the umbilicus. As it is a regional anesthesia, you will be awake and breathing on your own, with absolutely no pain of surgery. Moreover, you will have pain relief up to 2 to 3 hours after surgery which gives the time for your pain medications to take over. Present day spinal anesthesia is very safe and comfortable as it is given with a very thin spinal needle which is virtually painless. Contrary to the popular myths, there are no long term backaches or complications associated with spinal anesthesia.
- General anesthesia: In this type of anesthesia, drugs are given through intravenous route to make you unconscious. A tube is inserted in your throat to ventilate you through the surgery. You remain unconscious during your surgery and you are awakened by the anesthetist at the end of your surgery.
Although you may indicate your choice of anesthesia, It is advisable to let your anesthetist decide what anesthesia is best for you, depending on the choice of surgery decided by your gynecologist and the patient factors assessed by your anesthetist during your preanesthetic checkup.
Hysterectomy recovery time
Usually hysterectomy will take about 1-3 hours. After your surgery is done, you will be shifted to the recovery room where you will be kept for observation. During this time, your vital parameters are monitored, you are observed for bleeding and urine output and pain relievers are administered. After 3 to 4 hours, you may be allowed to have liquids. Once your vitals and urine output are stable, absence of bleeding is confirmed and you start taking orally, you are ready to be shifted to your room.
Once shifted to your room, you will receive your antibiotics, intravenous fluids, and other drugs. At the same time, your diet will be built up from liquids to semisolids to solids, you will be made to sit up, get out of bed and be mobilized. In most cases, you would be discharged on the 1-2 days after your surgery.
What are the side effects of hysterectomy?
Uterus has two main functions:
- Bearing children
- Menstruating
Once the uterus is removed, you will have following effects:
- You will never be able to bear children after the surgery
- You will never menstruate after surgery
- You may have some discomfort for a first few days which usually gets better on its own
- You may feel soreness at the site of your stitches
- If your ovaries are removed during the surgery and you already did not have menopause, then you might start feeling sudden onset of menopausal symptoms like hot flashes, vaginal dryness, depressed feeling, loss of sexual desire. Your doctor can easily treat the symptoms with adjustments in your diet and putting you on hormone replacement therapy to relieve your symptoms.
How long does a recovery take after hysterectomy?
Because of better surgical and anesthetic techniques and less tissue trauma, time for recovery from surgery has drastically reduced. The incisions have become smaller, surgery practically bloodless and procedures stitchless. Along with this, excellent pain relief techniques allow quick mobilization and return to normal activity. Discharge after 1-2 days is the norm today as compared to 5-7 days of hospitalization in the past.
Although you will be allowed to walk, climb stairs and do minor chores, your doctor will advise you against bending or lifting weights as the internal tissue requires at least 6-8 weeks time for complete healing.
Are there any long term side effects of hysterectomy?
A very frequently asked question-are there any long term side effects of hysterectomy like deterioration of vision, hair loss, weight gain?
These are common misconceptions.
The deterioration in vision happens because of aging. Hair loss usually happens after menopause due to change in hormones. Weight gain usually happens with slowing down of metabolism with aging. If you take a good balanced diet, avoid missing your meals for long intervals and exercise regularly, then usually the weight gain does not happen.
When can I have sex after hysterectomy?
After the removal of uterus and the cervix, the vaginal canal is left behind for sexual intercourse. There are stitches at a top of this canal which take about 6 weeks time to heal. Therefore you should avoid sexual intercourse for 6 weeks. Use a good lubrication when you resume sexual intercourse. You need not worry about getting pregnant after this surgery as your uterus is already removed.
What are the complications of this surgery?
Like in any other major surgery, hysterectomy may also be associated with complications like blood loss, infection, injury to the adjacent organs, drug reactions and complications of anesthesia.
These complications can be minimized by getting your surgery done in with an expert surgeon in a good surgical center. A good preoperative work up by the gynaecologist, preanesthetic workup by the anesthetist and proper surgical planning before surgery, goes a long way in reduction of risks and complications associated with hysterectomy. In the absence of major medical issues, the risk of surgery remains about 1% in good centers.
Post operative instructions after the surgery?
Common post operative instructions which I give to my patients after this surgery are:
- Avoid bending and lifting weights more than 3 kg
- Avoid pushing heavy objects like table, almirah or opening a bed box.
- You should never get up from the bed straight, you should first turn to one side and then use your hands to lift yourself out of the bed.
- Avoid sexual intercourse for 6 weeks.
- Avoid abdominal exercises for at least 3 to 6 months.
- Do some light exercise everyday like walking. Stay active at home.
- Wound care as advised by your surgeon.
Carry home message
Hysterectomy or removal of uterus is a commonly performed procedure. In most of the cases, it can be done laparoscopically which causes lesser pain, lesser scarring, lesser blood loss and ensures quicker recovery. A detailed preoperative workup by the surgeon and proper planning of the surgery are the key for good results. You should understand the plan of your surgery from your surgeon and that of anesthesia from your anesthetist. You can also indicate your choices about the technique of surgery or anesthesia. Post surgery, early ambulation and early resumption of oral diet help in quicker recovery. Stay healthy!
For more such interesting information on women's health, kindly visit our website Expert Gynae Care and our YouTube channel @drnidhigarg
To consult Dr. Nidhi Garg, please visit us at Kamal Hospital, Doaba Chowk, Jalandhar-144004 or Visit our website kamal Hospital jalandhar or Expert Gynae Care