Dr Dimple Doshi

HYSTERECTOMY SURGERY

The meaning of the word hysterectomy surgery is the removal of the uterus.The word hystero means uterus and ectomy mean removal. 

For every woman uterus is a symbol of womanhood and the monthly period is a sign of youthfulness.

But at the same time uterus is the cause of many problems for many patients; problems severe enough to make life hell.  When all medicines fail and all conservative approaches fail, hysterectomy is the last resort to get relief from the troubles. However, it is an emotionally traumatic decision.

Heavy menstrual bleeding, severe pain during the periods, prolapse, and cancer are some of the commonest reasons for which hysterectomy is done.

In routine hysterectomy ovary and vagina are preserved so the feminity, sexuality, strength, and vitality are maintained.

Dr. Dimple Doshi is an expert gynecologist for conservative management of female concerns like heavy bleeding and offers hysterectomy surgery as the last option. She is an expert in various types of hysterectomy surgery as well as post-hysterectomy treatment to maintain physical and mental health and vitality.

Dr. Dimple Doshi at Vardaan Hospital; believes prevention is better than cure, and thus apart from the precise treatment guidelines; preventive measures are an essential part of our consultations with the patients who have either had it or want to know more about it.

Hysterectomy is the surgical removal of the uterus. It may also involve the removal of one or both the ovaries and the fallopian tube depending upon the condition for which it is being done.
  • Total hysterectomy: The uterus is removed along with the cervix
  • Subtotal hysterectomy: The uterus is removed but the cervix is left intact.
  • Pan hysterectomy: The uterus is removed along with both the fallopian tubes and ovaries.
  • Radical hysterectomy: This is meant for the cancer of the uterus.
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Methods of doing hysterectomy:
  • Abdominal hysterectomy:  Here the abdomen is opened up to remove the uterus.
  • Vaginal hysterectomy  Here the uterus is removed only through the vagina.
  • Laparoscopic hysterectomy: It is done using a laparoscope and other high-end laparoscopic instruments.
  • Laparoscopy-assisted hysterectomy: here the majority of the steps of hysterectomy are done laparoscopically the uterus is removed vaginally and the vagina is closed from below
  • Robotic hysterectomy: Done with the robotic system.

Some common indications of hysterectomy are:

 

  • Heavy menstrual bleeding
  • Uterine fibroids
  • Adenomyosis causes severe abdominal pain during menses and heavy bleeding
  • Endometriosis causes severe pain during menses
  • Uterine prolapse or the uterus coming down
  • Cancer prevention and treatment.
  • Chronic pelvic pain.
  • Postpartum or after delivery to prevent heavy blood loss.

 

Hysterectomy surgery has drastically evolved in recent times from the technique of opening the abdomen to minimally invasive; keyhole laparoscopic hysterectomy to the stitchless vaginal hysterectomy to the robotic hysterectomy performed with the ultramodern robotic instruments. The need to open the whole abdomen is slowly being obviated with the advent of advanced technology and patient satisfaction with the best cosmetic element. Given below are descriptions of various methods of hysterectomy surgery.

 

Abdominal Hysterectomy Surgery

Hysterectomy is done by opening up the abdomen; also called laparotomy is called abdominal hysterectomy

Incision: 10 to 12 cm vertical or transverse incision on the abdomen.
Recovery: 4 to 6 weeks’ time
Stay in the hospital: 4 days
Indications:
1. Complex hysterectomy surgery like a very large uterus
2. When there is a history of multiple abdominal surgeries; 3. When done for cancer or when the patient is not fit for other methods like laparoscopic or vaginal hysterectomy.

Advantage: It is the method of choice when the above-mentioned indications are there.

Disadvantages: prolonged stay, prolonged recovery; the presence of a big incision

Vaginal Hysterectomy

Hysterectomy surgery done from below or vaginally is called a vaginal hysterectomy

 

Incision: No incision on the abdomen
Recovery: one week
Stay in the hospital: 2 to 3 days
Indications: uterine prolapse or whenever it is possible to remove the uterus vaginally even when there is no prolapse

Advantage: faster recovery as there are no stitches on the abdomen

Hysterectomy surgery done from below or vaginally is called a vaginal hysterectomy

Incision: No incision on the abdomen
Recovery: one week
Stay in the hospital: 2 to 3 days
Indications: uterine prolapse or whenever it is possible to remove the uterus vaginally even when there is no prolapse

Advantage: faster recovery as there are no stitches on the abdomen

“Robotic hysterectomy” is a modern method of laparoscopic surgery using special remotely controlled robotic instruments that allow the surgeon finer control as well as three-dimensional magnified vision.

  • You will be asked to do certain blood reports like your hemoglobin, blood group, sugar levels, liver and kidney screening tests, X-ray chest, ECG, etc. as advised by your doctor. Your fitness to undergo surgery and anesthesia is ascertained.
  • You will be admitted a night prior or on the same day depending upon the convenience of your surgeon and you.
  • You will be asked to stop certain medications like aspirin, anticoagulants, and contraceptive pills. At the same time, you may be asked to continue your thyroid, diabetes, blood pressure, or epilepsy medicines if they are being taken by you.

Most women who undergo hysterectomy surgery have no serious problems or complications from the surgery especially if done by an expert and experienced surgeon. However, hysterectomy surgery is considered major surgery and is not without risks. The complications include:

Bleeding

Injury to surrounding structures

Wound infections

Blood clots

Urinary incontinence

Fistula or an abnormal connection between vagina and bladder

Chronic pain

Urinary incontinence.

Stay: After a laparoscopic hysterectomy, you will be advised to go home after 1 to 2 days, and in the case of an open hysterectomy, you will be discharged after 4 days.

Diet: You will be advised to have a full diet from the second day

Mobilization: You will be encouraged to walk from the same day if hysterectomy surgery is performed by laparoscopy and in case of open and vaginal hysterectomy surgery, you will be allowed to walk after 24 to 48 hrs.

Pain: Pain with modern methods like laparoscopy is minimal. And you will be given round-the-clock pain killers to smoothen your recovery.

Dressing: The dressing will be waterproof, so you can take a thorough bath.

Bath: You can take bath after you are discharged. However, in the hospital, you may be given a sponge bath.

Follow-up: 6 days after the hysterectomy surgery is done.