Hysterectomy is a surgery to remove the uterus. A hysterectomy is done for many reasons including, but not limited to the following:
- Heavy menses refractory to medical management
- Pelvic pain
- Pelvic organ prolapsed (when the uterus is “dropping”)
- Gynecological cancer
There are two categories of hysterectomy:
- Total hysterectomy is removal of the entire uterus, including the cervix.
- Supracervical hysterectomy is removal of the uterus, but NOT the cervix. If you have had an abnormal Pap smear or have certain types of pelvic pain, this surgery may not be recommended. In addition, up to 5-10% of women may continue to have light cyclic menstrual-like bleeding after surgery. Research has shown that sexual function and pelvic support (i.e. future risk of prolapse) after supracervical hysterectomy is identical to that after a total hysterectomy. Benefits to supracervical hysterectomy include slightly faster surgery and shorter recovery time.
There is a misconception amongst many women that a hysterectomy also includes removal of the tubes and ovaries. This is not the case. It may or may not be done with the hysterectomy. The surgical terminology is called a “salpingo-oophorectomy”. Removal of the tubes and ovaries leads to menopause (if you are not already there), and in many situations, we recommend leaving them in. There are risks and benefits to ovarian removal and preservation that should be discussed with your provider.
Hysterectomy can be done with several techniques:
An incision on the abdomen is made (usually like a bikini-cut or c-section incision, but sometimes up and down) and traditional surgical instruments and techniques are used to perform the surgery. The hospital stay is usually 1-2 nights and the recovery is around 4-6 weeks. Restrictions include 1-2 weeks without driving, 4 weeks without heavy lifting, and 6-8 weeks without sexual intercourse. We usually reserve this method of hysterectomy for VERY large uteri, for cancer, or for very challenging cases where laparoscopic or vaginal techniques have failed.
An incision is made in the back of the vagina through which the uterus and cervix are removed. There are no incisions on the abdomen. The hospital stay is usually 1 night and recovery takes 2-3 weeks. Restrictions include a few days without driving, 4 weeks without heavy lifting, and 6-8 weeks without sexual intercourse. The advantage of this procedure as compared to an abdominal hysterectomy is a decrease in postoperative pain and recovery time. Not everyone is a great candidate for vaginal hysterectomy. One or more of the following could make a vaginal hysterectomy more difficult, but does not eliminate the possibility of having one: obesity, pelvic scarring (from prior c-section, myomectomy, infection or endometriosis), or a large uterus. In addition, for most providers, if you have not had a full-term vaginal birth, a laparoscopic approach may be more reasonable.
(total or supracervical) Three to five small incisions (0.5 to 1cm) are made in the navel and lower abdomen to allow the laparoscope and long narrow instruments to be placed through plastic tubes called ports. The hysterectomy (whether total or supracervical) can be achieved this way. We have success performing laparoscopic hysterectomies even with very large fibroids. Recovery is similar to the vaginal approach. Hospital stay is one night and recovery is 2-3 weeks. Restrictions include a few days without driving, 4 weeks without heavy lifting, and 6-8 weeks without sexual intercourse.
Robotic assisted Laparoscopic Hysterectomy
There is a misconception that robotic hysterectomy is a brand new surgery. A better way to think of it is that this is a new tool to perform an already established surgical technique. The surgery performed is nearly identical to a laparoscopic hysterectomy, except that the incisions are in a slightly different location. The DaVinci® surgical system is attached to the ports, through which special instruments are placed. The robotic system then translates the surgeon’s movements from outside the body into precise movements inside the abdomen. This system provides more flexibility with movements than does traditional laparoscopy. In addition, the camera view is superior. Recovery and restrictions are identical to laparoscopic hysterectomy. For more information you can visit DaVinciHysterectomy.com. Currently, Dr. Bernstien and Dr. Bass perform robotic hysterectomy.
What are the risks of surgery?
- Bleeding during or after the surgery
- Damage to structures in the abdomen and pelvis such as the bladder, bowels, ureters (the tubes that take urine from the kidney to the bladder), blood vessels, nerves, and any other organ nearby
- Venous Thromoboembolism (VTE) — including Deep Vein Thrombosis (DVT) and Pulmonary Embolus (PE), which is a risk with any surgery
- Problems related to anesthesia
- Bowel blockage from scarring of the intestines
- Wound breakdown
- Death (VERY unlikely)
What should you expect during recovery?
- Pain: You will have some pain the first few days after the surgery, but your pain should improve on a daily basis. We will provide you with prescription strength pain relievers. You should take ibuprofen for baseline pain control and additionally take a narcotic medication if needed.
- Bleeding: You may have bleeding and mild discharge from the vagina for 4-6 weeks. If you are having heavy bleeding (soaking through a pad an hour) then we must be notified. Sanitary pads can be used post operatively; however, no tampons for 6 weeks.
- Constipation: In addition you may have constipation for a couple of weeks secondary to the anesthesia and the pain medication. We recommend colace daily and Miralax as needed.