Dr. Sneha Trivedi Ob-Gyn Speciality Clinic

A hysterectomy is the surgical removal of the the womb (uterus).

Hysterectomy for non-cancerous reasons is usually considered only after all other treatment approaches have been tried without success.

This surgery may be done for different reasons, including:

• Uterine fibroids that cause pain, bleeding, or other problems
• Uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal
• Cancer of the uterus, cervix, or ovaries
• Endometriosis
• Abnormal vaginal bleeding
• Chronic pelvic pain
• Adenomyosis, or a thickening of the uterus

• Total hysterectomy: Removing your uterus and cervix, but leaving your ovaries.
• Supracervical hysterectomy: Removing just the upper part of your uterus while leaving your cervix.
• Total hysterectomy with bilateral salpingo-oophorectomy: Removing your uterus, cervix, fallopian tubes (salpingectomy) and ovaries (oophorectomy). 
• Radical hysterectomy with bilateral salpingo-oophorectomy: The removal of your uterus, cervix, fallopian tubes, ovaries, the upper portion of your vagina and some surrounding tissue and lymph nodes.

Vaginal hysterectomy:

•  The uterus is removed through an incision at the top of vagina. There isn’t an external incision.
• Dissolvable stitches are placed inside vagina.
• Most commonly used in cases of uterine prolapse and other nonmalignant (or noncancerous) conditions.
• Fewest complications and fastest recovery (up to four weeks) and considered the preferred approach.
• People often go home on the same day of surgery.

Laparoscopic hysterectomy:

• A laparoscope (a thin tube with a video camera on the end) is inserted in patient’s lower abdomen through a small incision in belly button.
• Surgical tools are inserted through several other small incisions.
• Uterus can be removed in small pieces through the incisions in abdomen or through your vagina.
• Some people go home the same day or after one night in the hospital.
• Full recovery is shorter and less painful than an abdominal hysterectomy.

Robotic-assisted laparoscopic hysterectomy

• The procedure is done with the help of a robotic machine.
• A laparoscope is inserted in patient’s abdomen so the pelvic area can be viewed.
• Small, thin surgical tools are inserted through three to five incisions around patient’s belly button. Robotic arms and instruments are controlled by the surgeon.
• The recovery is similar to a laparoscopic hysterectomy.

Abdominal hysterectomy:

• Uterus is removed through a six- to eight-inch-long incision in abdomen.
• The incision is made either from patient’s belly button to pubic bone or across the top of patient’s public hairline. The surgeon will use stitches or staples to close the incision.
• Most commonly used when cancer is involved, when the uterus is enlarged or when disease spreads to other pelvic areas.
• It generally requires a longer hospital stay (two or three days) and a longer recovery time.

A hysterectomy is a common procedure that can improve symptoms caused by many different medical conditions. In some cases, the surgery can be lifesaving. 

• Stopping abnormal, heavy bleeding
• Relieving chronic pain
• Restoring pain-free sex
• Preventing cancer
• Removing cancerous tissue
• Improving quality of life

Most people who get a hysterectomy have no serious problems or complications from the surgery.

Still, a hysterectomy is major surgery and is not without risks. Those complications include:

• Urinary incontinence
• Blood loss and the risk of blood transfusion
• Damage to surrounding areas, like the bladder, urethra, blood vessels, and nerves
• Blood clots in the legs or lungs
• Infection
• Bowel blockage
• Side effects related to anesthesia
• The need to change to an abdominal hysterectomy from one of the other techniques.

Most people recover from a hysterectomy in about four to six weeks. Patient’s recovery depends on the type of hysterectomy had. Recovering from a vaginal and laparoscopic hysterectomy takes less time than recovering from an abdominal hysterectomy.

Patient should increase activity gradually and pay attention to how the patient is feeling. If anything causes pain, you should stop and consult doctor immediately.

Vaginal and laparoscopic recovery take about two to four weeks. It may take up to six weeks to recover from abdominal hysterectomy. 

When a hysterectomy isn’t medically necessary, some alternatives to try could be:

• Watching and waiting to see if the condition improves.
• Taking medications such as birth control pills to manage painful periods or abnormal bleeding.
• Burning of the lining of your uterus for heavy bleeding.
• Having procedures to shrink or surgery to remove uterine fibroids.
• Performing exercises for uterine prolapse that help improve the muscles in your uterus.
• Using a pessary to “prop up” your uterus if you have a uterine prolapse.
• Undergoing surgery to treat endometriosis or vaginal bleeding that doesn’t involve removing the entire uterus.