By: Beth Walsh for Fibroids1When many women think of a hysterectomy, they imagine a big scar, much discomfort, a long recovery period and a drastic impact on some of their basic bodily functions. The rate of non-invasive hysterectomies, however, is steadily increasing – and this technique minimizes virtually every negative aspect of the traditional hysterectomy.
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The three most common conditions treated with hysterectomy are fibroid tumors, endometriosis, and uterine prolapse. Fibroids alone account for 30 percent of hysterectomies performed. Cancer is the reason for another 10 percent of hysterectomies.
In most cases, hysterectomy is an elective procedure. Women must be sure that their symptoms are severe and problematic enough to undergo the surgery. Remember, this is a non-reversible procedure.
If you are considering a hysterectomy, be sure you understand the risks and benefits of the procedure, the type of surgery that will be performed and any alternative treatments. For anything other than cancer, there are drugs and other therapies that might be worth trying before going through a surgical procedure. |
A hysterectomy is a surgical procedure in which the uterus is removed. A total hysterectomy means that the uterus and cervix (the piece of the uterus that stabilizes the uterus by attaching to large ligaments in the pelvis) are removed. A hysterectomy does not include removal of the ovaries and fallopian tubes, but frequently these structures are removed as well during a hysterectomy.
Hysterectomy is the second most common major operation performed in the United States, second only to cesarian section. Approximately 600,000 American women have this procedure every year, at a cost of more than $5 billion. By the age of 60, one out of every three women in the United States has had a hysterectomy. Oftentimes, a hysterectomy is performed to remove fibroids, which are non-cancerous uterine tumors. The majority of women will experience a fibroid or fibroids during her lifetime.
Since the 1940s, hysterectomies have been performed either by making an incision in the abdomen (either a "bikini" incision or a vertical incision between the belly button and the pubic bone) or, if the uterus is not too large, an incision in the top of the vagina (a vaginal hysterectomy). When an incision is made in the abdomen, several layers of skin, muscle and tissue are cut. This cut is what causes the significant post-operative pain and recovery time. It is actually the healing of the skin and other layers beneath it that accounts for most of the pain women experience after a hysterectomy, not the actual removal of the uterus. A vaginal hysterectomy reduces the pain of recovery, but can only be performed on women who have a relatively small uterus and have no other diseases or prior surgeries that may have caused adhesions. Also, the cervix must be removed in a vaginal hysterectomy.
Endoscopic, or minimally invasive, surgery has been used in mainstream medicine since the late 1980s. The use of a laparoscope (a small fiber-optic rod with a light source and video camera) lets the surgeon use a video monitor as a guide during the procedure. The surgeon can insert various instruments through other small, “keyhole” incisions.
A laparoscopic supracervical hysterectomy (LSH) is performed through three small incisions – one is in the base of the belly button and the other two are smaller incisions near the hip bones. The uterus is cut away from its blood supply and from the cervix. The surgeon then removes the organ, in strips, through a tube. This procedure can be done in women with mild to moderate adhesions and can be done in the case of a large uterus. The fallopian tubes and ovaries can also be removed during this type of procedure. A laparoscopic total hysterectomy can also be performed in women who need to have their cervix removed.
LSH is widely considered superior to other procedures because it preserves sexual function by saving the cervix and its mucous-secreting glands and avoiding vaginal dryness, the most common complaint after regular hysterectomies. Studies have shown than LSH offers the shortest operating time and shortest hospital stay compared with other types of hysterectomy. Furthermore, the ligaments that support and hold in place the cervix and vagina are left intact during LSH.
A laparoscopic total hysterectomy is similar to a LSH, but the surgeon also removes the cervix. If the uterus is not greatly enlarged, the uterus (and possibly the tubes and ovaries) are removed vaginally, and the top of the vagina is sewn closed with sutures placed through the laparoscope. The surgeon then incorporates the uterosacral ligaments to support the top of the vagina.
