by Karen Schroeder, MS, RD
Anatomy and Physiology
A woman's reproductive organs include the vagina, uterus, fallopian tubes, and ovaries. A hysterectomy is the surgical removal of the uterus, which is the womb. After a hysterectomy, you will no longer menstruate and will be unable to become pregnant.
If the ovaries and fallopian tubes are also being removed, the procedure is called a hysterectomy with salpingo-oophorectomy. Once your ovaries are removed, you will become menopausal if you are not already.
Reasons for Procedure
A hysterectomy may be done to treat a variety of gynecologic conditions, including: uterine cancer, uterine fibroids, uterine prolapse, endometriosis.
Uterine cancer is a malignant growth of endometrial cells, which line the uterine cavity. It can cause abnormal vaginal bleeding and pelvic pain.
Uterine fibroids are benign, non-cancerous growths of uterine muscle cells on or within the wall of the uterus. They are far more common than uterine cancer. Fibroids can cause pain and/or a pulling sensation in the pelvis, as well as heavy and/or irregular menstrual bleeding. They sometimes lead to infertility.
Uterine prolapse occurs when the uterus slips down into the vagina. This often occurs during times of pelvic stress, as when straining on the toilet. Uterine prolapse can lead to pain and a feeling of fullness or pulling in the vagina, and may cause vaginal discharge, leaking of urine, or inability to fully empty the bladder or rectum.
Endometriosis occurs when the uterine lining grows outside the uterus. Because this tissue continues to release menstrual-type blood, it can cause irritation and scarring in the abdomen and pelvis. Depending on its location, endometriosis can cause pain during sexual intercourse, around the time of menstruation, and when going to the bathroom. It may also lead to infertility.
Often, non-surgical treatments can be effective alternatives to hysterectomy. For example, medications can help treat endometriosis and uterine fibroids, and certain exercises can help manage mild cases of uterine prolapse. Non-surgical approaches are clearly preferable in pre-menopausal women who wish to have children. But in uterine cancer, eliminating the cancer with hysterectomy or radiation is preferred to medical therapy.
Hysterectomies may be performed using one of several methods: An open hysterectomy is done through an incision in the lower abdomen. In a vaginal hysterectomy, the uterus is removed through the vagina. A laparoscopic-assisted vaginal hysterectomy, or LAVH, is a vaginal hysterectomy aided by surgical instruments inserted through small "keyhole" incisions placed in the abdominal wall.
In the days leading up to your procedure: Arrange for a ride to and from the hospital and for help at home as you recover. The night before, eat a light meal and do not eat or drink anything after midnight. If you regularly take medications, your doctor may recommend temporarily discontinuing them. Do not start taking any new medications before consulting your doctor. You may be given laxatives and/or an enema to clean out your intestines.
An LAVH generally takes 2-3 hours and can be done under general, spinal, or epidural anesthesia. In general anesthesia, you will be put to sleep for the duration of the procedure. In spinal or epidural anesthesia, you will be awake but numb in the lower half of your body.
A catheter will be placed into your bladder to drain your urine during surgery.
To begin the procedure, your surgeon will make several small "keyhole" incisions, called ports, in the abdomen. He or she will pump carbon dioxide gas through one of these ports to inflate your abdomen, which makes it easier to see the structures inside.
Your surgeon will then insert a laparoscope-a thin instrument that contains a light, a magnifying lens, and a camera-through one of the ports. The camera transmits images to a monitor.
Your surgeon will make an incision around the cervix and slip additional instruments through the other ports. He or she will cut the uterus free from the surrounding tissue and pass it out through the vagina. During a salpingo-oophorectomy, the ovaries and fallopian tubes will be removed in the same manner.
Finally, your surgeon will stitch the top of the vagina closed, place gauze packing inside the vagina to absorb and minimize postoperative bleeding, and close the small abdominal incisions with stitches.
Risks and Benefits
An LAVH is considered very safe. However, there is a chance that the following complications may occur: damage to some of the structures around the uterus, infection, problems with bladder and bowel function, bowel blockage, bleeding, heart and lung complications, blood clots in the legs that could travel to the lungs.
Benefits of an LAVH include: effectively treats a variety of conditions, generally results in fewer complications, less scarring, and a shorter recovery period than an open hysterectomy, eliminates the risk of future uterine or cervical conditions, including cancer, fibroids, and prolapse, eliminates the risk of ovarian cancer if ovaries are also removed, serves as permanent contraception for pre-menopausal women who have completed their families.
In an LAVH or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate treatment choice for you.
After the Procedure
After your surgery, you will be taken to the recovery area for monitoring. The typical hospital stay after an LAVH is 1-2 days. You will be offered pain medication and you may be given antibiotics to prevent infection. The catheter and the gauze packing will be removed before you go home.
Recovery from LAVH takes 2-4 weeks. The day after your procedure, you will be encouraged to get out of bed and walk. During the first two weeks of recovery, you will be advised to avoid all lifting, to get a lot of rest, and then to slowly increase your activity.
After you leave the hospital, be sure to contact your doctor if you experience: a fever, faintness or dizziness, nausea and vomiting, shortness of breath, heavy bleeding, leaking from, or opening of, the incision, pain when you urinate, swelling, and/or redness, or pain in your leg.
- American College of Surgeons. Hysterectomy. Available at: http://www.facs.org/public_info/operation/hysterectomy.pdf. Accessed October 22, 2003.
- Hysterectomy. Queensland Government website. Available at: http://188.8.131.52/informedconsent/ConsentForms/og/hysterectomy.pdf. Accessed March 9, 2004.
- Jelovsek FR. Urinary tract injuries during LAVH. [Society of Gynecologic Surgeons Web site]. Available at: http://www.sgsonline.org/edps001.html. Accessed October 22, 2003.
- The National Women's Health Information Center. Hysterectomy. Available at: http://www.4woman.gov/faq/hysterectomy.htm. Accessed October 22, 2003.
- U.S. National Library of Medicine and the Patient Education Institute, Inc. X-Plain: Hysterectomy. Available at: http://www.nlm.nih.gov/medlineplus/tutorials/hysterectomy/og019101.html. Accessed October 21, 2003.
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