What hysterectomyÂ surgical options are available?
To perform a hysterectomy, the surgeon reaches your internal reproductive organs either through an incision in your lower abdomen, through laparoscopic (keyhole) surgery via small abdominal incisions or vaginally. Hysterectomy is performed under general anaesthetic. The surgeon first cuts the ligaments that keep the uterus suspended in your abdomen, then the supporting structures (pedicles) that attach the uterus to neighboring internal organs, and finally ties off the arteries that supply the uterus with blood.
Your hysterectomy surgical options depend on the amount of time and facilities available, the extent of your disease, the size of your uterus, and the skill of your surgeon.
If your uterus is enlarged it may require a large abdominal incision for removal. Your incision will most likely extend vertically between your pubic bone and your navel to enable the obstetrician to see the internal organs well and to provide adequate room to manipulate the instruments. The scar will be immediately visible because of the size. Abdominal incisions are more painful than vaginal incisions, so your hospital stay will be extended. Most hysterectomies (75%) are performed abdominally.
If your hysterectomy is a planned (elective) operation, as most are, then you have more choices. If your uterus is not greatly enlarged, you may be a candidate for removal:
- Vaginally, through a small incision in the rear of the vagina, which does not leave a visible scar and is suitable for prolapse (where the uterus extends into the vaginal passage or beyond)
- Laparoscopically, with two or four tiny incisions in the abdomen through which a laparoscope camera and pen light areÂ inserted, so the surgeon can see to disconnect the uterus from its moorings and pull it out through the vagina, which leaves only small scars and is suitable for a small uterus
- Abdominally through a â€˜bikini cutâ€™, a horizontal 10 centimeter to 15 centimeter incision under your pubic hair line, where it is not immediately visible
Your surgeon may remove:
- All of your reproductive organs entirely (radical), or
Only the uterus above the cervix and retain the cervix for sexual function (supracervically with worrelling), or
- Oophorectomy (ovaries only), or
Salpingo-oophorectomy (fallopian tubes and ovaries)
Who requires a hysterectomy?
The incidence of hysterectomy depends on where you live. Hysterectomy is most prevalent in the U.S.A., especially in the Midwest and South among African-American women. Every year, over 550,000 American women have hysterectomies. It is the second most prevalent form of female surgery. Fifty-five percent of hysterectomies are performed on young women between the ages ofÂ 35 and 49. One-third of American women experience hysterectomy by the age of 60. The high rate of American hysterectomy has been questioned by foreign observers, who estimate 30% of American hysterectomies are unnecessary.
In recent years, the total number of hysterectomies is decreasing, but more American women under the age of 40 are hysterectomized. For some, it is for prevention of ovarian and uterine cancer due to genetic predisposition. For most, removal of the uterus is the recommended option by physicians because conventional pharmaceutical drug treatments do not adequately treat uterine fibroids, heavy menstrual bleeding and/or endometriosis.
Understand more on Hysterectomy:
The information in this article has been taken with permission from the official Lawley booklet onÂ Understanding Hysterectomy.