Hysterectomy

Hysterectomy (plural: hysterectomies), the surgical resection of the uterus, is the most commonly performed gynecological procedure in the USA ³. It is usually performed electively.

Epidemiology

Approximately 600,000 hysterectomies are performed in the United States annually. After Cesarean section, it is the commonest performed gynecological procedure in women of childbearing age in the USA (CDC data 1994-1999) ³.

Types

There are two basic types in the non-cancer patient

• (total) hysterectomy: removal of the uterus only
• supracervical (subtotal) hysterectomy: removal of the uterine body, cervix left in situ

These may be performed vaginally, laparoscopically or as an open surgery, such that the main types are

• abdominal hysterectomy (AH): open surgery via laparotomy
• vaginal hysterectomy (VH): removed via the vagina
• laparoscopic supracervical hysterectomy (LASH)
• laparoscopically assisted vaginal hysterectomy (LAVH)
• total laparoscopic hysterectomy (TLH)

Often a salpingo-oophorectomy is performed during the same surgery. This involves unilateral/bilateral removal of the ovaries and fallopian tubes.

Robotic assistance may also form part of some procedures now ³.

Radical hysterectomy

In cancer patients, a radical/extended hysterectomy may be performed, which most commonly comprises the removal of the uterus, cervix, upper vagina and parametrium. A concurrent salpingo-oophorectomy is also often performed. Although there are actually a broad spectrum of possible radical hysterectomies, the details of which are outside the scope of this article ².

Indications

The most common underlying conditions leading to hysterectomy are ⁴:

• uterine fibroids
• menstrual disorders
• adenomyosis of the uterus
• endometriosis
• uterine prolapse
• premalignant abnormalities of the cervix and endometrium

Complications

Intraoperative

• hemorrhage
• iatrogenic injury to
  • bladder (commonest injury, up to 1% cases) ¹
  • bowel
  • ureter
  • blood vessels
• anesthesia-related complications

Postoperative

• sepsis
• hematoma
• pulmonary embolism (PE)/deep vein thrombosis (DVT)
• fistula formation
• wound dehiscence
• revision/secondary operation
• rectocele