A Hysterectomy can bring permanent relief to women experiencing excessive menstrual bleeding or the constant pelvic pain and cramping associated with several medical conditions. The Centers for Disease Control and Prevention estimates that approximately 600,000 hysterectomies are performed each year in the U.S. It's the second most common surgery among women today, trailing only behind Caesarean sections.
"Hysterectomy refers to the surgical procedure performed to remove a woman's uterus," says J. Chris Portera M.D., OB/GYN doctor at WISH, Chattanooga, TN and medical director of the CHI Memorial Continence Center. "There are several reasons a patient may choose to have a hysterectomy. She may have uterine fibroids, endometriosis, uterine prolapse, heavy bleeding that can't be controlled with hormonal treatments or more conservative surgeries, or she may have a gynecologic cancer that requires the surgery."
Hysterectomies are performed in different ways. Sometimes the surgery requires the removal of just the uterus, while other surgeries remove the ovaries and fallopian tubes as well. Patients who have both ovaries removed during their hysterectomy will enter menopause and may experience hot flashes, mood swings, sleep disturbance, and other menopausal symptoms.
"In younger patients, there's actually a push these days to remove the fallopian tubes and leave the ovaries, if possible," Portera says. "The belief is that some cancers originate from the ends of the fallopian tubes and by removing the tubes along with the uterus may lower the patent's risk of developing cancer."
As with other surgeries, some hysterectomy techniques are more invasive than others.
"The least invasive approach is a vaginal hysterectomy where the uterus is removed through a small incision at the top of the vagina," Portera says. "Vaginal hysterectomies typically have fewer complications and the fastest recovery times, and there are no visible scars."
Another minimally invasive option from our Chattanooga OB/GYN practice is laparoscopic hysterectomy. The pelvic surgeon makes three small (5 mm) incisions in the patient's belly. Surgery is performed while the patient is under general anesthesia using a laparoscope (a tube with a lighted camera) and surgical tools inserted through tiny cuts. The surgeon holds and directs the tools from outside the body while viewing the operation on a video screen. Most patients undergoing laparoscopic hysterectomies go home the same day, and recovery is typically one to two weeks.
"A lot of my patients are asking about robotic-assisted hysterectomies," says Portera. "Robotic-assisted hysterectomy is performed through four or five small incisions in the belly, and the surgeon uses a computer to direct and conthrol the instruments."
The robotic control system translates the surgeon's hand movements. Recovery for this type of procedure is similar to recovery for laparoscopic hysterectomies. Some patients go home the same day or after a one-night hospital stay. Most can go back to work - light duty- in two weeks.
The most invasive type of hysterectomy is the abdominal hysterectomy, where pelvic surgeons make a 5 to 7 inch cut - either vertically or horizontally - in the lower part of the abdomen and remove the patients uterus through the incision. Patients undergoing abdominal hysterectomies typically have more pain, require longer hospital stays (one to two days), and need more time to recover than women who have less invasive procedures.
Women considering having a hysterectomy should talk to their OB/GYN doctors and weigh their options before making their decision. A hysterectomy can be a life-changing - and sometimes, a life-saving surgery.
J. Chris Portera M.D. is a Gynecologist, Urogynecologist and Reconstructive Pelvic Surgeon at Women's Institute for Specialized Health in Chattanooga, TN.