Vaginal hysterectomy

Vaginal hysterectomy

What is a hysterectomy?

A hysterectomy is a surgical procedure done to remove a womans womb or uterus. The uterus is the organ where the baby grows. It is one of the most commonly performed gynecologic surgical procedures for women. A hysterectomy can either be total or partial, depending on whether the entirety or only a part of the uterus is taken out. In some cases, the fallopian tubes and the ovaries may also need to be removed. After a hysterectomy is performed, menstruation ceases, and the woman can no longer get pregnant.

Types of hysterectomy:

  • Partial, subtotal, or supracervical removes just the upper part of the uterus. The cervix is left in place.
  • Total removes the whole uterus, including the cervix.
  • Radical removes the whole uterus, the tissue on both sides of the cervix, and the upper part of the vagina. This is usually done when cancer has spread to the surrounding structures.

How is a hysterectomy performed?

There are different ways in which the doctor can perform a hysterectomy. This includes:

Abdominal hysterectomy -n this type, a 5-7 inch incision is made longitudinally or laterally in the lower part of your abdomen to gain access to the uterus.

  • Vaginal hysterectomy -  In this approach, the uterus is removed through the vaginal canal after an incision is made in the womans cervix.
  • Laparoscopic hysterectomy - A laparoscope is an instrument with a thin, lighted tube and small camera that allows your doctor to see your pelvic organs. Three-Four small incisions are made in the abdomen to insert the instruments needed to remove the uterus.
  • Laparoscopically assisted vaginal hysterectomy (LAVH) - Your doctor will remove your uterus through the vagina. The laparoscope will be used to better view the pelvic structures during the procedure.
  • Robotic surgery - Your doctor uses a special machine to perform the surgery. This is usually done fore patients with cancer, or overweight individuals who cannot opt for the vaginal approach.

What is Vaginal Hysterectomy?

A vaginal hysterectomy involves removing the uterus through the vaginal canal. This is ideal when the uterus is not enlarged or when the uterus has dropped as a result of the weakening of surrounding muscles. This approach is technically more difficult than the abdominal procedure because it offers the surgeon less operating space and less opportunity to view the pelvic organs. However, it may be preferred if a patient has a prolapsed uterus, if the patient is obese, or in some cases if the patient has early cervical or uterine cancer. A vaginal hysterectomy leaves no external scar.

A variation of the usual vaginal hysterectomy is the LAVH (laparoscopic-assisted vaginal hysterectomy). A laparoscope is a flexible tubular instrument that the surgeon uses to view the inside of the pelvis. The LAVH approach involves making a few small incisions in the abdomen, after which, the uterus is removed through the vaginal canal.

Risks and Complications

As with any type of surgery, a hysterectomy also has its own risks and complications. Some of these include excessive blood loss, clot formation, and infection. Surgical risks are higher in women who are obese, diabetic, or hypertensive.

The location of the uterus in the pelvis means there is a risk of injury to other pelvic and abdominal organs during the surgery, including the ureters, the bladder, or the bowel. The risk of organ injury is greater if large fibroids, severe endometriosis or cancer obstructs the surgeon's view, making surgery a lot more difficult.

Candidates

Vaginal hysterectomy treats many different gynecologic problems, including:

Fibroids. Fibroids are benign tumors in your uterus that can cause persistent bleeding, anemia, pelvic pain, pain during intercourse and bladder pressure. If you have large fibroids, you may need an abdominal hysterectomy.

Endometriosis. Endometriosis occurs when the tissue lining your uterus (endometrium) grows outside of the uterus, including the ovaries, fallopian tubes, or other organs. Most women with endometriosis have an abdominal hysterectomy, but sometimes a vaginal hysterectomy is possible. Gynecologic cancer. If you have cancer of the uterus, cervix, endometrium or ovaries, your doctor may recommend a hysterectomy to take the cancer out. Most of the time, an abdominal hysterectomy is done for gynecologic cancer, but at times a vaginal hysterectomy may also be appropriate.

Uterine prolapse. When pelvic supporting tissues and ligaments weaken, the uterus can descend or sag into the vagina, causing urinary incontinence, pelvic pressure or difficulty with bowel movements. A hysterectomy is sometimes recommended to relieve the symptoms.

Abnormal vaginal bleeding. When medications or less invasive surgical procedures cannot control irregular, heavy or very long periods, a hysterectomy is sometimes recommended.

Chronic pelvic pain. If you have chronic pelvic pain clearly caused by a uterine condition, a hysterectomy may chosen, but only as a last resort. Chronic pelvic pain can have several causes, so an accurate diagnosis is critical before having a hysterectomy.

For most of these conditions with the possible exception of cancer a hysterectomy is just one of several treatment options. You may not even need to consider a hysterectomy unless medications and less invasive gynecologic procedures have failed. Keep in mind that you cannot get pregnant after you've had a hysterectomy. If you're not completely sure you're ready to give up that possibility, explore other treatment options.

The Effects

Depending on the reason for the surgery, previously experienced signs and symptoms will no longer be present if the hysterectomy was done as a form of treatment. Pelvic pain may be relieved, bleeding may stop, and cancer may have been removed because of the hysterectomy.

The procedure

The patient will be put under general anesthesia, so she won't be awake for the surgery. The legs will be placed in stirrups, similar to the position required for a Pap smear. Sometimes, a urinary catheter is passed through the urethra to empty the bladder. The vagina is cleansed with a sterile solution prior to the surgery.

To perform the hysterectomy, the surgeon makes an incision inside the vagina to access the uterus. Using long instruments, the surgeon cuts the uterus away from the blood vessels, connective tissue and fallopian tubes.

The uterus is removed through the vaginal opening, and absorbable stitches are used to control any bleeding inside the abdomen. Except in cases of suspected uterine cancer, the surgeon may cut an enlarged uterus into smaller pieces before removing it in sections (morcellation).

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Recovery

When the surgery is done, the patient is then sent to the recovery room for a few hours of monitoring. Minimal pain and discomfort may be felt after the procedure, but proper prescribed medication may be given to relieve this.

After a hysterectomy, you'll no longer have menstrual periods or be able to get pregnant. If you were still having periods before the surgery and your ovaries were not removed, you'll continue producing hormones and eggs until you reach menopause. If your ovaries and fallopian tubes were removed with your uterus, you'll begin menopause immediately after surgery and may experience symptoms such as vaginal dryness and hot flashes.

Recovery after a vaginal hysterectomy is shorter and easier than after an abdominal hysterectomy. Most women feel better within a week and make a full recovery in one to two weeks. It is advised to avoid heavy lifting and sexual intercourse for at least six weeks.

Emotional effects after vaginal hysterectomy

After hysterectomy, many women report improved mood and increased sense of well-being. Others enjoy life more because they're no longer experience previous symptoms of bleeding or pelvic pain. Some women feel a sense of loss and grief after hysterectomy, which is quite common. Others may experience depression related to losing the ability to become pregnant.

FAQs

Q: What exactly is a hysterectomy?

A: A hysterectomy is a surgical procedure in which the uterus, or womb, is removed. Depending on a variety of factors, the doctor may remove one or both ovaries and the fallopian tubes as well. The doctor may choose the traditional approach by doing an abdominal hysterectomy (which includes an incision in the lower abdominal wall) or she may opt to perform a vaginal hysterectomy.

Q: Is a Vaginal hysterectomy better than an abdominal hysterectomy?

A: Several studies have shown that with the vaginal approach, healing time is lessened and the risks and complications are greatly reduced. Although a vaginal hysterectomy does have its advantages, not everyone can opt for this approach. Women who are extremely overweight, or who have large uterine fibroids, may not be candidates for the vaginal type of hysterectomy.

What Q: What are some reasons a woman undergoes a hysterectomy?

Q: What is an oophorectomy?

A: An oophorectomy means removal of the ovaries. If for some medical reason the ovaries must also be removed, the surgeon does an oophorectomy along with a hysterectomy..

Is Q: Will I go through the menopause after I have a hystectomy?

A: Since a hysterectomy only removes the uterus and estrogen and progesterone are made in the ovaries, a hysterectomy without an oophorectomy typically does not cause a lot of menopausal symptoms. However, if your physician performs a hysterectomy along with an oophorectomy, or if for some reason your doctor feels a need to perform an oophorectomy without a hysterectomy, you would experience menopausal symptoms. If your ovaries are removed, your physician will talk to you about options for estrogen replacement therapy (ERT) or hormone replacement therapy (HRT), whichever is deemed appropriate for you.

Q: What are the problems associated with the removal of the uterus at early age, say between 35 40 yrs of age?

A: A hysterectomy is only performed if the womans condition (uterine bleeding, chronic pelvic pain, etc.) remains to be untreated by medications or other conservative methods. Removing the uterus would mean removing the organ where a baby usually grows. If the uterus is removed at an early age, the woman will no longer be able to get pregnant in the future. No other body function will be affected if only the uterus is removed. If the ovaries are also taken out, hormonal changes will occur and menopause would most likely begin.

: What is the importance of removing or conserving the ovaries?

A: The physiological functions of the female body are maintained by the estrogen (hormone needed for normal female sexual development and for the healthy functioning of the reproductive system) secreted by the ovary. Removing the ovary before menopause therefore deprives the woman of this hormone leading to early menopausal changes. Therefore, unless there is a strong reason to remove the ovaries (like suspicious pathology, strong family history of an ovarian or a breast cancer, cysts, tumors) they should be conserved as much as possible.

Q: Can removing the uterus at an early age accelerate the menopause?

A: No, removing the uterus does not accelerate the onset of menopause.

Q: Is the sexual performance affected after a hysterectomy?

A: No, a hysterectomy does not affect sexual performance. As long as the ovaries are not removed, there will be no changes in the desire, arousal, and orgasm.

Q: Can you have bleeding or discharge after hysterectomy?

Q: Can hysterectomy be done by vaginal route if there are multiple or big fibroids (common tumor-like growths in womans reproductive system)?

A: Generally yes, except in some rare cases wherein the large size of the fibroid or its difficult location makes it unsafe for the doctor to perform this procedure using the vaginal approach.

Q: Can the uterus still be removed by the vagina route even if the woman has had previous caesaran sections?

A: Yes. In fact, the vaginal route would be preferred for this case to avoid any complications that may arise if an abdominal approach is taken.

Q: Do you put on weight after hysterectomy?

A: No, weight gain has no relationship whatsoever with the removal of the uterus.

Q: Can the removal of the uterus cause visual disturbances?

A: There has been no evidence to prove that hysterectomies can cause visual disturbances.

Q: How soon can one resume routine work and activities?

A: After a vaginal or a laparoscopic hysterectomy, the patient can resume his/her daily activities in a matter of 1-2 weeks.

Q: What are the precautions to be taken after undergoing hysterectomy?