A hysterectomy is a surgery in which there is removal of the uterus(womb), tubes and usually the cervix(neck of the womb). Depending on your age and the reason for the surgery, removal of one or both of your ovaries may be needed.
Conditions that may require a hysterectomy include large fibroids, adenomyosis, abnormal uterine bleeding, pre-cancerous changes or cancerous changes of the female pelvic organs.
A hysterectomy can be performed in a few ways:
Laparoscopy(minimally invasive): Small cuts made on the abdomen (about 1cm). Carbon dioxide is released into your abdomen to facilitate the surgery and a scope is inserted for viewing. Instruments are then placed through the small cuts to perform the surgery. A colpotomy(cut in the top of the vagina) will be made to remove the uterus through the vagina. This cut will then be repaired. Sometimes, morcellation(breaking of the uterus into smaller pieces) may be necessary to remove the employed
Laparotomy (open): a cut of about 10-15cm is made on the abdomen. This can be horizontal or vertical
Vaginal: the site of operation will be assessed through the vagina with no cuts on the abdomen
Robot(minimally invasive): Similar to laparoscopy, small cuts will be made on the abdomen and carbon dioxide released into your abdomen to facilitate the surgery. The surgeon will be seated at the console and instruments are attached to the robot’s arms. These arms act as an extension of the surgeon’s arms, mirroring every hand movement.
The choice of surgery depends on a few factors including the size of your uterus, operation complexity as well as patient factors and surgeon expertise. As with all surgeries, complications can sometimes occur even with the best effort of the surgical and nursing teams. Some of these are inherent in any operative procedure. If complications do occur, recovery may take a longer period of time and further procedures may be necessary.
Here are some risks and complications that may occur and this list is not exhaustive:Common complications include bleeding and infection, wound complications(infection, breakdown, delayed healing, keloid formation), pain or numbness over the wound siteOther less common complications include injury to the surrounding organs(e.g. urinary bladder, bowels, blood vessels etc), formation of clots in the deep veins, scar tissue formation etc. Rarely, after a hysterectomy, the end of the vaginal tunnel which was repaired, may give way. This may result in bleeding and bowels slipping through the vagina, requiring emergency surgery. In certain circumstances, if a laparoscopic surgery was planned, it may be converted to an open surgery due to technical difficulties or complications encountered. If the cervix was not removed during the operation, there is a 5% chance of persistent blood-stained discharge or cyclical vaginal bleeding. Even if the cervix was planned to be removed prior to the operation, sometimes the cervix may be left behind to minimize complications such as bleeding and injury to surrounding organs.