Different Types of Hysterectomy and Basic Repairs

So—you are being told by your doctor that you may need a hysterectomy?

Let’s make sure you understand what this means, so you can have a good discussion with your gynecologist, and really understand your consent form.

“PARTIAL OR COMPLETE HYSTERECTOMY”

First of all, I want to set you all straight about “complete” and “partial” hysterectomy.  A hysterectomy is not about the ovaries!!

A HYSTER ectomy is removal of the uterus

A SALPING ectomy is removal of the tubes

An OOPHOR ectomy is removal of the ovaries

SO…..

A PARTIAL HYSTERECTOMY is removal of the upper part of the uterus, and leaving the cervix behind.

Sometimes, the cervix is not removed because it is too difficult to do at the time of surgery, or because the patient would like it left in to preserve sexual  function—although there is no evidence that removal of the whole uterus is going to hurt your sex life.  There is also a morcellation procedure that leaves the cervix in–you recover faster and can get back to work—it’s a big deal to miss paychecks! Not everybody has paid “sick-time”.

There is also a morcellation procedure that leaves the cervix in–you recover faster and can get back to work—it’s a big deal to miss paychecks.

CLICK ON PICTURE and it will be much clearer!

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Now—how do we get the uterus out?

More than one way to do this!

ABDOMINAL HYSTERECTOMY

This is done by opening your tummy–usually with a “bikini” cut–but sometimes “up and down”.

This surgery may be chosen if your doctor suspects that it will be difficult to remove your uterus due to scar tissue, or previous surgeries, or because the uterus is big, or other issues–you can discuss the reasons why with your doctor.

VAGINAL HYSTERECTOMY

This a removal of the uterus through the vagina (and you CANNOT DO A PARTIAL HYSTERECTOMY THROUGH THE VAGINA).  You have to cut the cervix out to get to the rest of the uterus.

One does a hysterectomy this way if there is some PROLAPSE (the uterus is “dropped”).  It means no cuts on the tummy, and that you, typically, will recover faster.  May be possible if you have had a vaginal birth.

When a vaginal hysterectomy is done, you MAY also be told that you need some sort of VAGINAL REPAIR-a bladder lift and/or a “back-end” repair.  A bladder repair is done for a “dropped” bladder-CYSTOCELE.  A back-end repair is known as a RECTOCELE repair.

One CAN sometimes get the tubes and ovaries vaginally, but it can be more difficult to get them.  Imagine that we are trying to get an orange out by going through a toilet roll–and we can’t see EVERYTHING sometimes.

CLICK HERE to see a video of a vaginal hysterectomy–WARNING-it IS surgery!!!  Might be too gross!

Any time you go for vaginal surgery, there is always a chance that you may have to go for open surgery—if there is bleeding it is sometimes too difficult to find the bleeder from the vaginal end–sometimes a laparoscopy (keyhole surgery),  can be done–to save a larger incision.

The bladder and the rectum are literally ‘right there’–I know in pictures they draw the bladder at least a cm, away but in reality, it is about the difference of a cover of a phone book—same for rectum.   It is NOT unusual to make a hole in the bladder or–less often– the rectum, that needs to be fixed during the surgery.   The bladder is the more common organ damaged.  This typically heals well, but you may have to go home with a catheter in for up to a week.

LAPAROSCOPIC ASSISTED VAGINAL HYSTERECTOMY

If it is essential to remove the ovaries, your doctor made offer you a laparoscopic approach to surgery.  This is “keyhole” surgery – 3-5 small  incisions.

In some centres, DaVinci robotic surgery is being offered.   This is a nice option for bigger women, especially.   Not every hospital has robotic surgery.   If you can get uterus out vaginally, then there isn’t much more that a DaVinci procedure can offer.  It sure is nice though for cancer surgeries!

RISKS OF LAPAROSCOPIC SURGERY

ORGAN INJURY -HITTING SOMETHING WE DON’T WANT TO HIT

We use sharp tools, and there is always a chance that the tool could hit something underneath that nobody wants to be touched–your bowel, your blood vessels, your bladder.   The 3Bs.

Hitting a blood vessel can be something like a small vessel under the skin, and leave you with a bruise, or a hematoma (collection of blood)–which can leave you a pretty wicked looking bruise. You can also hit any small branch of a blood vessel and have one just not stop bleeding—-transusionmay be needed!

There are two major blood vessels in your abdomen–your aorta and your vena cava–these are MAJOR vessels, and hitting one is a SERIOUS problem, requiring your belly to be opened FAST to save your life!!

Your BOWEL can be hit–and this is also a MAJOR problem, that may require your belly to be opened, some of your bowel removed, and maybe a bag on your belly (an ostomy)–which may be temporary or permanent.  If you get SICK after your surgery, YOU MUST SEEK HELP!!

RISK OF INFECTION

Despite use of antibiotics to reduce your risk of infection, those darn bacteria are EVERYWHERE, and they now have drug-resistance developing at an alarming rate.
If you are concerned about your wound, get seen. I would venture to say–get back to the doctor who did your surgery, if possible–or at least that hospital, but if not possible—just get the wound seen!

RISK OF BLOOD CLOTS IN YOUR LEG VESSELS, LUNGS

You will have something done to try and prevent blood clots–it may be a blood thinner, stockings that pump your circulation while you are asleep and after in recovery, or both.  These will REDUCE your risk of a clot but will not eliminate your risk.

A clot in your leg may not make your leg swell, but there is usually some ache or discomfort. We worry about leg clots because they can break off and go to your lungs.

A clot in your lung, can be fatal.  You may have some symptoms, such as shortness of breath, or a sharp pain in your chest when breathing.  You need to seek medical attention quickly.

These are the stockings that we use to try and prevent clots in the leg.  They pump up gently every minute or two to keep the circulation moving.

SCAR TISSUE–ADHESIONS

Everybody scars differently.  Some people have no scar tissue, unless you look really closely; others can have great mounding hard angry looking scars!   Inside the belly, you may form scar tissue, which can stick your bowel to places that cause problems such as pain, or bloating or trouble getting bowel movements to get through (bowel obstruction).

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Removal of your uterus alone does not interfere with your ovaries working They will continue to make your female hormones until your OVARIES pack it in! The only difference will be the lack of bleeding. You are NOT “in menopause” just because you have your uterus out. If you are, for instance, 37 and getting your uterus out,then you will likely not hit menopause for at least another 15 years.

Most gynecologists will see you for a post-op(eration) check about 6 weeks after the surgery. We want to check the incisons, if any, and certainly check the top of the vagina to make sure all has healed well. PLEASE do not have intercourse until the vagina has been checked out.

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