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|How Is A Hysterectomy Performed?
While there are a few different types of hysterectomy, the operation is basically performed in one of two ways: one is to remove the uterus (womb) through the vagina and the other is to remove it through an incision in the abdomen. Generally a vaginal hysterectomy is preferred by surgeons because it leaves no visible scar and the healing time is faster. If however there are too many endometrial adhesions or very large uterine fibroids, an abdominal hysterectomy is usually performed. This is because it is easier for the surgeon to see where he is working and there is less risk of injuring the bladder or urethra. While a vaginal hysterectomy is considered the safest and most cost-effective of the two surgeries studies show that abdominal hysterectomy is performed 66 percent of the time and vaginal hysterectomy in 22 percent of cases (a further 12 percent are laparoscopic or keyhole hysterectomy, using special instruments and smaller incisions either vaginally or abdominally). Both operations require staying in hospital (1-2 days for vaginal operation and 3-5 for abdominal) and require general or local anesthesia. Before either operation various urine and blood tests will be done and sometimes an enema is recommended to clear out the colon. Just before the procedure an ultrasound scan or CT scan may be carried out to confirm the location of any adhesions, fibroids or tumors. The pubic hair will be also be shaved.
This operation takes about an hour, but in complex cancer cases it can take quite a bit longer. You will probably be asked to wear compression stockings to help prevent blood clots from forming in your legs (see hysterectomy complications) and you may be injected with heparin, an anti-clotting drug. You will also be given a dose of antibiotics to preempt any infection. The surgery is performed under general anesthetic. The surgeon makes an incision across your lower abdomen, just above the bikini line (about 4-6 inches or 10cm, see pictures). If you have large fibroids (picture) or wide scale endometriosis he may need to make a vertical incision instead from the belly button down to the bikini line because it gives more visibility. Which type of incision is used will be agreed before surgery. Next, the tubes connecting the uterus to the fallopian tubes and blood vessels are cut and tied. Or if the ovaries or fallopian tubes are to be taken out, they will be removed at this point. The womb is gently lifted out and removed. While the surgeon is in the 'area', he may also remove your appendix to prevent the possibility of appendicitis in the future. Again, this will be agreed before surgery. There is some debate among doctors about preserving the woman's cervix, as it is believed the cervix plays an important role in sexual response and orgasms. However some doctors feel the evidence is not strong enough to justify routinely leaving the cervix behind. This is something you need to think about, (as well as other hysterectomy side effects) and agree the course of action before surgery. The abdomen is stitched back together and a protective dressing placed over it. A nurse will advice you about the hysterectomy recovery procedure.
This procedure can be performed with a general or local anesthesia. The patient is placed in the same way they would be for a pelvic examination. The operation takes about an hour. The surgeon uses specially designed instruments to make a small cut on the vaginal wall, through which he cuts the womb free of its surrounding ligaments and blood vessels. The womb is then removed through the vagina (picture). If the doctor performs a Laparoscopically Assisted Vaginal Hysterectomy (LAVH), he makes a small incision in the abdomen through which a small lighted camera is inserted to guide the surgeon. The uterus is still removed through the uterus. This procedure allows more visibility. The vagina is then stitched using dissolvable stitches and a tampon-shaped dressing is inserted into the vagina called a pack. There will be no visible scars, or if a LAVH is performed, you might have small marks on the tummy.
Laparoscopic hysterectomy means the laparoscopic procedure is used to remove the uterus (in the UK it is called keyhole surgery). It is an alternative way of performing an abdominal hysterectomy in women whom a vaginal hysterectomy is not feasible or safe. Instead of making a long incision in the abdomen, several tiny incisions are made instead. Through these incisions a laparoscope is inserted. This is a versatile surgical tool which can have a variety of medical instruments attached to it, from a cutting tool to a camera or light. The uterus is cut into pieces (and the fallopian tubes and ovaries if planned) and removed through the tiny incisions. The cervix is usually left in place. As it is less invasive, recovery time is much faster, the hospital stay is cut down from several days to just several hours. If a woman is not a candidate for a full procedure, she may be offered a LAVH, which combines laparoscopic technology with a vaginal hysterectomy (picture). A lighted laparoscope is used to guide the surgeon, but the cutting is still done through the vagina and the womb is removed vaginally. Women with very large fibroids, cancer or a history of cervical problems are usually only candidates for the traditional abdominal hysterectomy.
A robotic assisted hysterectomy is like something from a science fiction book (picture). As it is a new procedure it is not yet routinely performed. It is usually considered where a woman has cancer or is very obese and a vaginal hysterectomy is not considered safe. During the surgery, the patient lies on the operating table and a machine with 'arms' with surgical instruments attached is placed above her. The surgeon sits nearby at a computer console and controls the movement of the machine's arms from the computer. The benefit is, the machine overcomes the limits of the human hand and allows the surgeon to get into tiny spaces more easily. It even allows him a better view of the organs than with laparoscopic (keyhole) surgery. In effect it is a robot assisted laparoscopic hysterectomy. One such surgery is called da Vinci surgery. Robotic assisted procedures are still new and are being continually being improved.
I had a LAVH 2 months ago. I suffered from really heavy periods that made me worn out, anemic and I was in pain every day from menstrual cramps. I went for an ultrasound and found that my uterus was swollen. My doc performed a biopsy but it came back negative. He started to talk about endometrial ablation but then said I might have adenomyosis and that ablation wouldn't take care of it. He recommended a LAVH instead. I agreed. I ended up with 4 small incisions, one in my belly button, one on either side and in the center of my bikini line. The first week I was very tired and when I tried to do anything I got a lot of pain. As each week passed I could gradually do more with less pain. It has taken nearly 6 weeks to go, but I also suffered from a swollen belly which seemed worse at nights. This is finally going. I cry a lot for no reason, and I'm not sure yet if my ovaries have kicked in. While initially I looked into alternatives to hysterectomy, all said and done, it was worth it. My periods are much better.
The doctors tried to a robotic hysterectomy but were unsuccessful and ended up doing an abdominal hysterectomy instead. My legs were swelling for a few weeks after, but I found it improved when I wore support stocking and moved around the house. I assume that my doctor took out my cervix. He didn't mention it, so I don't know.
I had a partial vaginal hysterectomy at 27. They took out my womb vaginally with no incision. They have to move your bladder to one side do it. My recovery time was very short, I was driving by the third day. They did it vaginally (no incision) and they always have to move your bladder when they do that... at least they did with me. Unfortunately though I suffered from recurrent urinary tract infections for at least a year after.
I just had a radical abdominal hysterectomy (basically took everything out) because I suffered really badly from ovarian cysts which kept rupturing causing unbelievable pain. The surgeon said it was a good thing that I opted for the surgery because it turns out my ovaries, bowels and womb had all stuck together. I haven't been able to lift anything heavy for drive for the past 3 weeks, but so far the lack of real pain has made it worth while.
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