Hysterectomy

Hysterectomy is a surgical procedure to remove the uterus. It is a very common type of surgery for women. Removing the uterus means that you can no longer become pregnant.

Hysterectomy is used to treat many gynecological conditions. Some of these conditions include:

• Uterine fibroids (the most common reason for hysterectomy)
• Endometriosis
• Pelvic organ prolapse (such as uterine prolapse)
• Abnormal uterine bleeding
• Chronic pelvic pain
• Gynecological cancer

Depending on the gynecological condition, other treatment options may be considered before deciding on a hysterectomy, such as monitoring or medication. Some women choose to delay a hysterectomy until they have completed their family planning. If you opt for an alternative treatment, keep in mind that additional procedures may be necessary in the future.

Types of Hysterectomy

There are different types of hysterectomy:

• Total hysterectomy: The uterus and cervix are removed.
• Subtotal (supracervical) hysterectomy: The upper part of the uterus is removed, but the cervix remains in place.
• Radical hysterectomy: The uterus and cervix are removed along with surrounding structures. This surgery is recommended if cancer is diagnosed or suspected.

Women at risk of ovarian or breast cancer may choose to remove both ovaries or only the fallopian tubes, even if these organs are healthy, to reduce cancer risk. This is called bilateral prophylactic salpingectomy or salpingo-oophorectomy.

Removing the fallopian tubes (but not the ovaries) at the time of hysterectomy is also an option for women without a high cancer risk. This procedure, known as opportunistic salpingectomy, may help prevent ovarian cancer and provide permanent contraception. Discuss with your surgeon the potential benefits of fallopian tube removal during the procedure.

If the ovaries are removed, patients may experience immediate menopause symptoms and have an increased risk of osteoporosis and cardiovascular disease. Hormone therapy (HRT) may be prescribed to relieve menopause symptoms and help reduce the risk of osteoporosis and heart disease. HRT can begin immediately after surgery.

Surgical Approaches to Hysterectomy

Hysterectomy can be performed in different ways:

• Vaginal hysterectomy – The procedure is performed through the vagina.
• Open (abdominal) hysterectomy – The procedure is performed with an open incision (either vertical or transverse).
• Laparoscopic or robotic hysterectomy – The procedure is performed through small incisions (3-4 incisions, each smaller than 1 cm) in the abdomen.

The choice of surgical method depends on the reason for the surgery and other factors. Sometimes, the final decision is made after surgery has started, allowing the surgeon to assess any additional concerns.

Recovery After Hysterectomy

Recovery time depends on the type of surgery (open, laparoscopic, robotic, or vaginal), the underlying gynecological condition, and other factors such as the patient’s medical history and age.

• Pain is expected in the first few days after surgery. Patients receive specific combinations of pain relief medications for better comfort.
• Some women may experience light vaginal bleeding or discharge for a few days after surgery.
• Early mobilization is crucial – patients are encouraged to start moving on the same day as the surgery and resume eating the same day.
• Hospital stay duration:
  • 24 hours for laparoscopic, robotic, or vaginal hysterectomy.
  • 2-3 days for open hysterectomy, depending on the type of incision and the reason for the procedure.

The Thely-Clinic team of specialists has extensive training in leading centers for complex gynecological and gynecologic oncology surgeries, personalizing surgical treatment for each patient. They follow internationally recognized Enhanced Recovery After Surgery (ERAS) protocols to ensure faster recovery and reduced postoperative complications.