Hysterectomy

Hysterectomy is currently the second most common surgical procedure performed in the U.S., but its use is declining as doctors and patients seek alternatives that don’t affect fertility or require hormone therapy. Alternatives are discussed at the end of this entry.

Several conditions can warrant a hysterectomy:

• Ovarian cancer
  
• Ovarian cysts
  
• Fibroids, which account for 1/3 of all hysterectomies
  
• Cervical Cancer
  
• Endometriosis, which accounts for 1/5 of all hysterectomies
  
• Pelvic Inflammatory Disease (PID)
  
• Severe prolonged uterine bleeding
  

Hysterectomies can be performed in several ways. These procedures differ in difficulty of recovery; however, they all require 3-7 days hospitalization and up to two months recovery time before resuming your normal activities:

• In a vaginal hysterectomy, the doctor makes an incision at the cervix, and then cuts the uterus from the ligaments connecting it to the body. The cervix is disconnected from the bladder and both uterus and cervix are removed through the vagina. The ovaries and fallopian tubes can also be removed in this way. The vaginal hysterectomy requires less recovery time in the hospital than the abdominal hysterectomy, and you will probably experience less pain after the operation.
  

• An abdominal hysterectomy is usually undertaken if the uterus is enlarged or if uterine cancer is the culprit. The incision is made in one of two ways—either a curved incision above the line of pubic hair, or a vertical incision from the belly button to the top of the line of pubic hair. The uterus and cervix, and, if necessary, the fallopian tubes and ovaries, are removed through this incision. This procedure is the most painful and requires the most recovery time.
  

• Hysterectomy performed with a laparoscope is used when an abdominal hysterectomy is not necessary but a vaginal approach is for some reason inaccessible. Recovery is much faster and less painful than the abdominal hysterectomy, but the actual procedure can take much longer, so if there is a risk of complications from prolonged surgery, the doctor may prefer the abdominal route.
  
  

  In the hysterectomy with laparoscope, one or more much smaller incisions are made. The doctor inserts the laparoscope through one incision, and other instruments may be inserted through other small incisions. These instruments are used to cut the uterus and cervix, and, if necessary, the ovaries and fallopian tubes. The organs are then removed through another small incision in the vagina. This operation should also be less painful then the abdominal hysterectomy.
  

There are different names for the procedures in which different organs are removed:

• Oophorectomy refers to the removal of the ovaries. Removal of the ovaries automatically causes menopause, and it may be desirable to go on hormone therapy. Oophorectomy can sometimes be performed without a hysterectomy. In this case, the woman is still able to conceive.
  
• Salpingectomy refers to the removal of one or both fallopian tubes. A fallopian tube might be removed if there is a pregnancy in it, or if its corresponding ovary is being removed.
  
• Radical hysterectomy refers to the removal of the uterus, cervix, ovaries, fallopian tubes, part of the vagina and part of the pelvic lymph nodes.