Hysterectomy

What is a hysterectomy?

Hysterectomy is a surgical removal of the uterus. It does not necessarily mean removal of the ovaries.

Why do I need a hysterectomy?

A hysterectomy may be advised for various reasons, such as:

• Uterine fibroids – when there are large or multiple fibroids that cause pressures, pain and discomfort, or produce heavy periods.
• Heavy or irregular menstrual bleeding – especially when the problem does not improve with first-line therapies.
• Endometriosis – in particular when endometriosis involves the uterus, leading to a condition called “adenomyosis”. The uterus becomes enlarged, resulting in heavy, painful periods
• Prolapse of the uterus – when the uterus prolapses into the vagina or beyond the vaginal open because of pelvic floor dysfunction or “weakness”,
• precancer change of the uterine line cells (atypical endometrial hyperplasia).
• persistent abnormal Pap smear results; or some precancer changes of the cells on the cervix.

These conditions can cause disabling level of pain, discomfort, severe disturbance to normal activities, or emotional distress.

For women with these unpleasant symptoms, hysterectomy can offer a welcomed cure.

What are the alternatives?

Heavy periods can be treated with medical therapies or resection of lining of uterus. Both of these methods have a failure rate. The only definitive treatment is the removal of the uterus, i.e. hysterectomy.

Fibroids can be removed with a surgical procedure called myomectomy. Myomectomy is generally recommended for women who are planning for pregnancies in the future. However, as the uterus is preserved after myomectomy, there are chances that fibroids may re-grow, or the symptoms may return before the woman reaches menopause. Hysterectomy offers a definitive treatment of problematic fibroids for women who no longer desire to get pregnant.

Our doctor would be happy to outline the available options and help to find out the best choice for you.

Different ways of hysterectomy

There are different ways to perform a hysterectomy. The choice of approach depends on diagnosis, pathology, prior pelvic surgeries, size of the uterus, and the preference and skill of the surgeon.

Abdominal (Open) hysterectomy – It is the most invasive type of hysterectomy because it involves a large incision in the abdominal wall, i.e. laparotomy. The incision may be either horizontal - the “bikini incision” – or vertical from just low the umbilicus (“bellybutton) down to the level of pubic bone. The operation is followed by a hospital stay of 4-5 days. Complete recovery takes around 6 weeks.

Vaginal hysterectomy – The entire hysterectomy is performed through the vagina. An incision is made in the upper vagina, and the uterus is pull down and removed from down below. The vagina is then sutured from below and there is no scar in the abdomen. This procedure is most appropriate for women who have delivered children vaginally and have significant prolapse, because the ligaments supporting the uterus have been stretched and the uterus is attached more loosely. Also, there should be no other significant pelvic pathology as the surgeon would not be able to fully assess the pelvis from the small incision in the vagina.

3. Laparoscopic hysterectomy – The uterus is removed entirely using the keyhole technique and the incision at the vagina is closed from above. There is no vaginal surgery with this technique.

Our specialty – laparoscopic hysterectomy

We are specialized in using laparoscopic (keyhole) surgery to replace the traumatic open surgery for hysterectomy. The surgeon makes tiny incisions (usually 0.5 – 1 cm) on the abdomen. The laparoscope, a miniature camera attached to a slender telescope and a powerful light source, is inserted through a small incision in the navel (“bellybutton”). This camera projects a clear image from inside the body onto a video screen. It enables the surgeon to have a close-up view of the female reproductive organs on a video screen and make a thorough assessment of the pelvis. As the image is magnified, the surgeon can identify the anatomy more clearly and perform a meticulous surgery. With the laparoscopic instruments, the uterus is detached and removed through a small incision at the top of the vagina.

Why use Laparoscopy?

The laparoscopic approach allows an operation that would have been done with open abdominal surgery.

Because the procedure is minimally invasive, laparoscopic surgery is a less traumatic way of removing the uterus. Compared to open abdominal procedures, it is associated with a dramatic decrease in pain, less scarring and faster recovery. Patient can often get up and move around on the first day after the hysterectomy. The hospital stay is typically 1 – 3 day only, and the patient can usually return to her normal activities after about two to three weeks. This is much quicker than having an open abdominal hysterectomy, where complete recovery would take up to 6 weeks.

Another advantage is reduced risk of infection, because tissues are not exposed as they are in open surgery.

In summary, a laparoscopic hysterectomy gives you the benefits of:

• less pain.
• less scarring.
• faster recovery.
• shorter hospital stay.
• earlier return to work and normal activity.

In comparison to vaginal hysterectomy, the cutting-edge camera technology allows laparoscopic surgeons to have an accurate view of all pelvic organs, and therefore have better control of bleeding and carry out a very precise surgery during laparoscopic hysterectomy. This is particularly important for women who have had previous abdominal surgery, Caesarean sections, pelvic infection or some gynaecological procedures.

Is it safe?

Studies have shown that in experienced hands, the risk of major complications with laparoscopic hysterectomy is similar to an abdominal open hysterectomy. These risks include those related to anaesthesia, bleeding and the need for transfusion, infection and damage to surrounding organs.

When discussing a surgery, our doctor will always go through with you the surgical risks in specific to your general health and gynaecological conditions.

What happens before the surgery?

You will have the opportunities to discuss any questions with our doctor before the surgery. You will have to sign a consent form, have some routine blood test and be told about what to eat in the days before surgery. You will also receive medication to help cleanse the bowel.

How long is recovery?

The average stay in hospital after a laparoscopic hysterectomy is 1-3 days. Most patients can get out of the bed and move around the day following the surgery and are eating and drinking normally within this period. This contrasts with open abdominal hysterectomy where the usual stay is 6-7 days and normal eating/drinking patterns can take 2-3 days.

The average return to work and normal activities is within approximately 2-3 weeks, compared to 6 weeks after an open abdominal surgery.

Our doctor will answer any of these questions during postoperative visits in the hospital and later at the follow-up visits in the clinic.

Will my sex life be the same?

Your vagina is preserved so you can maintain your usual sex life after a hysterectomy. In fact, many women experience better sex lives after having their uterus removed. This is because the uncomfortable symptoms have been cured, there is no more inconvenience of menstrual bleeding, and the couple does not need to practice birth control or worry about unplanned pregnancy. Indeed, many of our patients described that they have become a new happy woman after the hysterectomy!

We do advise a rest period of 6 weeks before resuming sexual intercourse after a hysterectomy. Our doctor will discuss this with you.

How about my female hormone function?

Uterus does not secret hormone. Its only functions are to carry pregnancies and to produce menstrual bleeding. Ovaries are the reproductive organs that secret female hormones.

If the ovaries are preserved during a hysterectomy, your female hormone cycles will continue until you reach the natural menopause. This avoids undesirable menopausal symptoms and reduces the need of hormonal replacement therapy (HRT). The hormones secreted from the preserved ovaries will continue to protect your bones and other bodily functions.

The current standard practice in Australia is to preserve the normal ovaries during a hysterectomy for women under 65 years old. Exceptions are when the ovaries are diseased, there is a strong family history of ovarian cancer, or when the woman’s symptoms are related to her female hormonal cycle.

In other words, a hysterectomy DOES NOT cause menopause unless the ovaries are removed at the same time. It does not speed up the ageing process.

Before the surgery, our doctor will go through the details of these options and help you to make an informed decision.