Hysterectomy Procedure Types and Indications

The surgical removal of the womb or the uterus is called Hysterectomy. Adjacent parts of the female reproductive system such as the fallopian tubes and ovaries may be also included in some other types of hysterectomy.

Like in most mammals, the uterus is the house that nurtures the unborn baby until it reaches the proper time to be delivered into the world. It is a pear-shaped organ and is a major hormone responsive reproductive sex organ of females. The uterus functions to accept the fertilized ovum of which passes through fallopian tube from the ovaries. It is where the fertilized ovum is implanted on the thick musculature of the endometrium to be nourished and wait its time to complete gestation. 

There are several types of hysterectomies and it is classified according to purpose and extent of invasiveness of the procedure. The procedure s performed by a gynecologist. Removal of the uterus renders the patient unable to bear children since the uterus is where the fertilized ovum will be implanted and be nurtured before childbirth. It has many has surgical risks as well as long-term effects. This is the reason why this procedure is only done when other treatment options are exhausted and cannot treat the problem. The removal of the ovaries or oophorectomy is frequently done together with hysterectomy to decrease the risk for ovarian cancers. As with any procedure, hysterectomy has risks and benefits. It will affect the hormonal balance of the person and it will also has long term effects so it will affect the rest of her life. It is imperative that the surgeon clearly explains the procedure and the patient understands the procedure to be done. It is the patient’s right to know what will happen to her body.

Indications

The indications for hysterectomy has a long list of situations such as certain types of reproductive system cancers, severe endometriosis, uterine and vaginal prolapses, chronic pelvic pain, and to remove a placenta previa or placenta percreta. These should only be done when other treatments have been used but still unable to manage the situation.

Types of Hysterectomy

Radical Vaginal Hysterectomy

This procedure is also called the Schauta’s Procedure. It is the complete removal of the uterus, cervix, upper vagina, and parametrium. This is indicated for cancer. It is a surgical approach to early carcinoma of the cervix, radical vaginal hysterectomy does not permit pelvic lymph node dissection but is useful in selected patients, such as in obese patients. Other parts such as the lymph nodes, ovaries and fallopian tubes are also usually removed in the procedure if needed. It is performed for severe uterine prolapse or prolapse accompanied by stress incontinence and for patients with pelvic relaxation or history of myomata, irregular uterine bleeding, which may lead to hemorrhage and shock, or a treated pre-malignant lesion.

What happens is the uterus is removed through the vagina. This consists of an incision of the vaginal wall and the pelvic cavity. Urinary incontinence, enterocele, and or rectocele may be simultaneously repaired by anterior and posterior colporrhaphies and with reconstruction of the pelvic floor. This can be a procedure to repair the other adjacent parts since the cavities are open. The advantage of this procedure includes restoration of normal anatomic relationship and preservation of vaginal function, such as in sexual intercourse. The ovaries are not usually removed. Contraindications of this procedure are immobility of pelvic organs, large uterus, a pathologic condition such as ovarian mass, or pelvic cancer.

 

Total Abdominal Hysterectomy

In an abdominal hysterectomy, the uterus is removed through an abdominal incision and opening of the peritoneal cavity. This type of hysterectomy includes the complete removal of the uterus and cervix, and may not include the removal of the ovaries. Normal ovaries are preserved for hormone production whenever possible in women under 45 years of age. This procedure is done with a vertical midline or transverse incision on the abdomen. The vertical type of incision is used for better exploration purposes. The fallopian tubes and broad ligaments are clamped and cut. When the ovaries are not to be removed, the surgeon suspends it to avoid adherence to the vaginal vault. The vaginal vault is incised and the cervix is dissected from the vagina. After the uterus is removed, the connective tissue ligaments are anchored into the vagina. After sutures and staples done, the surgeon is now ready to close the incision. The bladder, vaginal vault and the rectum are reperitonalized on their proper positions.

Subtotal Hysterectomy

Subtotal hysterectomy is the removal of the uterus without removal of the cervix.

Hysterectomies may be well assisted by the use of endoscopies or laparoscopies to carefully visualize the procedure with minimal invasion. Newer technologies have more minimal incisions and mobilization of pelvic contents for a faster procedure and with faster recovery.

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