Today, surgical removal of the uterus is a much easier operation to undergo for most women than it was in the past. Still, responsible gynecologic practitioners such as those at Lourdes recommend this procedure only if other forms of treatment are not an option or have not been successful, and the patient wishes to have her uterus removed to address disease or symptoms. While hysterectomy may solve any number of gynecologic conditions, it comes with its own set of additional personal and physical considerations that women must consider carefully. Lourdes gynecologists concur with this operation only after extensive evauation and thorough, informed conversations with the patient.
Hysterectomy is one of the most common forms of surgery for women in the U.S., where gynecologic surgeons safely perform hundreds of thousands of these procedures each year. In about half of these cases, the operation is intended to serve as definitive treatment for uterine fibroids or abnormal uterine bleeding. Other common reasons for the procedure include such conditions as uterine prolapse, endometriosis or cancer in the pelvic region.
|Patients who elect to undergo hysterectomy may have uterine fibroids; severe endometriosis; disabling, unresponsive menstrual cramps; unrelenting, heavy vaginal bleeding; or cancer, among other conditions.|
Lourdes’ experienced gynecologic surgeons use either a standard laparoscopic approach (which usually involves three small puncture incisions in the pelvis) or robot-assisted surgery (which requires four our five slightly larger hole-like incisions) in performing hysterectomies, depending on the size and condition of the patient, and the scope of the procedure.
Supracervical or Complete
Among decisions involved in removal of the uterus is the determination of whether to leave in place the lower portion of the organ, the cervix, sometimes called the “mouth” of the womb. The Lourdes team provides two types of hysterectomy:
- supracervical hysterectomy. In this operation, the surgeon removes all of the body of the uterus but leaves the cervix in place, for patients who are at low risk for cervical cancer. A sexually monogamous woman with a history of normal Pap smears, has a low risk of developing cervical cancer. In addition, leaving the cervix may help structurally, providing pelvic support to the vagina, bladder and rectum, and preventing prolapse. This is an important consideration if the cervix appears well supported prior to surgery. This support helps to prevent such conditions as stress urinary incontinence.Preserving the cervix may also help to preserve sexual function and satisfaction (although it is unlikely to have a connection to a woman’s orgasmic response.) Thus, if the patient has benign disease and no precancerous lesions, she may decide in favor of this approach. The disadvantage for the patient may be possible spotting and bleeding from endometrial cells retained on or around the cervix and the potential risk of cervical precancerous or cancerous lesions in the future.
- total/complete hysterectomy. In this version of the operation, the gynecologic surgical team removes the cervix along with the uterus. If the patient has risk factors for cervical cancer or has precancerous cervical disease (dysplasia)—or if the cervix is otherwise compromised or physically abnormal—the team will often recommend complete removal. Patient preference is strongly considered in making a recommendation on whether to preserve the cervix.The removal also of the ovaries and fallopian tubes that sometimes accompanies a total hysterectomy, is called a salpingo-oophorectomy. If the patient has precancerous ovarian lesions, or a strong family history or risk of ovarian cancer, the gynecologic team may recommend this removal of the ovaries. But if menopause is in the distant future and the woman can benefit from ovarian function, oophorectomy may be avoided.
- radical hysterectomy. Used only in cases of advanced gynecologic cancer, this approach removes the uterus and much of the surrounding tissues, including the lymph nodes and upper part of the vagina. In an extreme form of this surgery, called pelvic exenteration, the surgeon removes nearly all of the organs of the pelvis, including the bladder and the rectum. As part of the radical hysterectomy procedure, the surgical team will reconstructive surgery to restore as much anatomy and function as possible to the vagina, pelvic floor and other structures.
|Learn more about the advantages of robotic surgery.|
The Robotic-Assisted Option
Gynecologic surgeons can sometimes perform hysterectomy through the vagina. But if the uterus is enlarged—due to fibroids, cancer or other causes—open surgery through an abdominal incision has been necessary in the past. At Lourdes, hysterectomy has also been available laparoscopically. As a refinement of that minimally invasive approach, hysterectomy using the robotic system has become increasing the approach of choice in Lourdes gynecologic surgery program. This most up-to-date of surgical approachesrequires only small puncture-like incisions and makes it more likely that the patient can return home on the same day of surgery. It also reduces blood loss to less than an ounce of blood in many patients, making the operation an almost bloodless procedure.
Robotic-assisted surgery is particularly applicable to cases otherwise difficult to perform laparoscopically. The technology gives the surgeon maximum capability to address locations that can pose a challenge to operate on in the pelvis. For the less-common circumstance where a patient needs a traditional, open surgical hysterectomy, such a conventional approach remains a safe, viable option.
If the medical team reaches the conclusion that a patient needs a hysterectomy, the Lourdes surgeons discuss this recommendation with her and review the different types of procedures available. They describe the surgical options and the risks, advantages and benefits of each. The staff makes sure each patient understands the choices in order to make a fully informed consent.
The process leading up to the procedure is deliberate and well structured. For example, diabetes, hypertension or other significant chronic conditions must be stabilized or addressed before surgery.
Most patients returning to the hospital for their one-week post-operative visit after a hysterectomy arrive mobile and resuming activities again. The specialist discusses pathology results at that time.