 Medical
information
Hysterectomy
Hysterectomy is the surgical removal of the uterus. In consultation with her gynaecologist, a woman may consider having a hysterectomy for a number of reasons.
The operation is performed only when other treatments are unsuitable or have been tried without success.
Possible reasons for hysterectomy
- Uterine fibroids
- Unexplained heavy or irregular menstrual bleeding
- Prolapse of the uterus
- Adenomyosis
- Chronic and intense uterine pain not relieved by other treatments.
- Pelvic inflammatory disease (PID)
- Cancer
Vaginal hysterectomy
The operation is performed through the vagina. It is suitable if fibroids are
not too big. In some cases, a vaginal hysterectomy can be
more difficult to perform than an abdominal hysterectomy,
although this may not be the case of a prolapsed uterus. For
a vaginal hysterectomy, only dissolving sutures are used and
do not need to be removed.
Laparoscopically assisted vaginal hysterectomy
A hysterectomy can be performed using a laparoscope, a thin telescope-like tube with miniature video equipment that allows the gynaecologist to see the uterus and other organs. The laparoscope and other surgical instruments are inserted though several small incisions in the abdomen and manipulated by the gynaecologist.
Carbon dioxide gas is blown into the abdominal cavity to lift the abdominal wall clear of the uterus, bowel and bladder; this is done to give a clear view of the uterus and ovaries. The uterus is usually removed through the vagina.
This procedure often takes longer to perform than an abdominal
or vaginal hysterectomy. No large external cut is made, so
little scarring is seen on the skin. Laparoscopy is commonly
called “key-hole" surgery.
Conversion to open surgery: In some cases, the gynaecologist may find that it is not safe to continue the laparoscopic hysterectomy or vaginal hysterectomy due to unexpected or life-threatening problems. The gynaecologist may have to remove the uterus using open surgery, as described above under “Abdominal hysterectomy”. A woman may be disappointed that she has had open surgery instead of laparoscopic hysterectomy, but open surgery is done in the interests of her safety and well-being. It is best to discuss the possibility of converting to open surgery with your gynaecologist.
Abdominal hysterectomy
An incision about 10 to 20 centimetres long is made in the lower abdomen. This
may be a horizontal cut quite low on the abdomen (“bikini
line”), or a vertical cut from the navel to the pubic
bone.
This type of operation may be recommended if more extensive
surgery must be performed. It may also be the operation of
choice if large fibroids or if a lot of scar tissue is present
due to previous infection or surgery. If the gynaecologist
believes the operation will take a very, very long time, an
abdominal hysterectomy may be the operation of choice.
Possible side effects of surgery
Specific risks of hysterectomy
- Large blood loss, requiring blood transfusion
- Injury to organs near the uterus, such as the bladder,
ureters or bowel may be caused by instruments during laparoscopic
vaginal and abdominal hysterectomy
- Rarely, injury to major blood vessels
- During laparoscopy, a bubble of carbon dioxide may get into the blood stream. Called a “gas embolism”, it can travel to the heart and lungs, and may become life threatening. Although rare, it has caused deaths.
- If hysterectomy has been done because of chronic pain,
there is a possibility that pain may persist after the operation.
The information and illustration above is reproduced
from 'HYSTERECTOMY - a guide for Women', published by the
Royal Australian and New Zealand College of Obstetricians
and Gynaecologists and Mi-tec Medical Publishing. The complete
pamphlet is available from your doctor.
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