hysterectomy
All content is checked by medical journalists.A hysterectomy (removal of the uterus) is the surgical removal of the uterus. The term uterine extirpation is also used synonymously. The method is based on the clinical picture at hand. Read all about hysterectomy, how it works and the risks it carries.
What is a hysterectomy?
In a hysterectomy (from ancient Greek hystera meaning uterus and ectome meaning cutting out) the uterus is either completely removed (total extirpation) or only partially (subtotal extirpation). The cervix is preserved. If the ovaries are also removed, this is called a hysterectomy with adnexa.
The removal of the uterus is one of the most common procedures in gynecology. Depending on the method, different types of hysterectomy are distinguished. When it comes to the removal of the uterus, your doctor will determine which illness is present, how big and flexible the uterus is, whether there are any comorbidities and, of course, what your wishes are.
Abdominal hysterectomy
Abdominal hysterectomy is mainly used when the uterus is very large. The uterus is removed via an abdominal incision.
Vaginal hysterectomy
Vaginal hysterectomy uses the vagina to remove the uterus. This shortens both the operating time and the recovery phase after the uterus has been removed.
Laparoscopic hysterectomy
Laparoscopic hysterectomy is a minimally invasive procedure. The doctor removes the uterus with the help of instruments through small incisions in the abdominal wall over the vagina (laparoscopically assisted hysterectomy). If the uterus is separated above the cervix and partially removed through small incisions in the abdominal wall, the variant is called laparoscopically assisted supracervical hysterectomy. .
By removing the uterus, childbearing is irrevocably terminated, and menstrual bleeding no longer occurs after total extirpation. Slight cyclical bleeding can only occur with subtotal extirpation.
When to do a hysterectomy
The hysterectomy is usually only necessary for benign diseases:
- benign tumors such as myomas (muscle growths)
- Uterus myomatosus (enlargement of the uterus with multiple fibroids)
- Menstrual irregularities
- Endometriosis (the lining of the uterus, which is found outside the uterine cavity and can cause pain)
- Uterine prolapse (prolapse of the uterus)
On the other hand, malignant diseases or emergency operations are very rare:
- Cancer of the cervix, uterus or ovaries
- serious injury or inflammation
- insatiable bleeding after childbirth
What do you do with a hysterectomy?
First of all, your doctor will give you detailed personal advice and explain possible risks and alternative operations. In addition, contraindications such as an existing desire to have children or infections are excluded and a blood test is carried out.
In the case of uterine myomatosus and anemia due to increased bleeding, drug treatment (with GNRH analogues or a progesterone receptor modulator) may be useful before the operation in order to reduce the bleeding and shrink the fibroids.
In preparation for the operation, the anesthetist will inform you about the planned anesthesia and its risks. You must appear sober for the operation. This means that you are not allowed to eat or drink for a few hours before the hysterectomy. The urinary bladder is emptied with the help of a urinary catheter, which is removed immediately after the removal of the uterus or a few days later.
Abdominal hysterectomy
Since the surgeon removes the uterus through an abdominal incision, abdominal hysterectomy usually requires general anesthesia. If malignant diseases are found, the operation can be extended and additional tissue removed. Abdominal hysterectomy is also used if the uterus is very large or overgrown.
Vaginal hysterectomy
Vaginal hysterectomy can be performed under both general and local anesthesia. It is the method of choice for benign diseases. The surgeon removes the uterus through the vagina with the help of special instruments so that no visible scars are created. If the vagina is too narrow or the uterus is too big, the surgeon can remove the uterus in several parts (morcellation).
Laparoscopic hysterectomy
General anesthesia is also required for laparoscopic hysterectomy. The surgeon inserts a tiny camera with a light source (laparoscope) and instruments such as forceps, scissors and suction devices through small incisions in the abdominal wall. The abdominal cavity is inflated with carbon dioxide to improve vision.
If the uterus is removed through the vagina, it is called a laparoscopically assisted hysterectomy. If parts of the uterus are removed through the abdominal incisions, the procedure is called laparoscopically assisted supracervical hysterectomy.
What are the risks of a hysterectomy?
As with any surgery, a hysterectomy can cause excessive bleeding, injuries to neighboring organs, and problems with the anesthesia. Possible disorders after a hysterectomy are temporarily impaired bladder function, secondary bleeding, infections, proliferating scarring and adhesions.
What should I watch out for after the hysterectomy?
Slight tiredness and slight pain after the removal of the uterus are normal in the first few weeks. Sexual intercourse should only take place after four to six weeks in order not to strain the vaginal occlusion. Even heavy physical exertion should not be resumed until six weeks after the hysterectomy.
Your behavior after the removal of the uterus influences the healing process. Studies show an increased quality of life after hysterectomy. Consequences such as incontinence or loss of libido could not be proven. If the ovaries were also removed during the operation, typical menopausal symptoms can occur. Such problems after the removal of the uterus can be treated with hormones as part of the hysterectomy follow-up care.
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