Overview
Uterus removal surgery, also known as Hysterectomy, is a surgical procedure to remove the uterus or womb. The uterus is where the baby grows during pregnancy. The surgery is done to treat some conditions like fibroid, abnormal uterine bleeding, adenomyosis, uterine prolapse, etc. And certain types of cancers. Hysterectomy generally involves removing the uterus. However, the surgeon may also remove the ovaries and fallopian tubes in some cases.
After uterus removal surgery, one will not be able to get pregnant. Moreover, one will stop having menstrual periods after the surgery. This is a major surgical procedure that might be the last resort if the condition does not go away with other treatments and medications. The uterus removal surgery usually lasts one to three hours, depending upon the surgical procedure and condition of the patient. The recovery period of the surgery is generally six to eight weeks.
Who Are the Candidates for Uterus Removal Surgery?
Uterus removal surgery is performed to treat conditions like fibroids, chronic pain, gynecologic cancer, and more. Here are some of the conditions that may require uterus removal surgery:
- Fibroids
- Adenomyosis
- Endometriosis
- Abnormal uterine bleeding not controlled by medicines
- Pelvic inflammatory disease
- Uterine prolapse
- Ovarian, cervical, or uterine cancer
Factors increasing the risk during surgery:-
- Patients with previous abdominal surgery/infection have higher chances of adhesions
- Uncontrolled Diabetes, Hypertension, Thyroid disorder
- Medical disorders like Heart disease, Chronic kidney disease, etc.
- Obesity, Anemia
- Patient on blood thinners
How to Prepare for Uterus removal surgery?
Preparation for uterus removal surgery is similar to any other major surgery. The doctor will discuss the surgical procedure in detail and explain its benefits and risks. If there are any medical conditions, make sure that it is well-controlled before the surgery. The doctor may also prescribe specific tests like Pap smear(LBC), endometrial biopsy, or pelvic ultrasound to confirm the medical condition. ECG, Chest X-ray, and some blood tests are done to check fitness for Anesthesia. Apart from this, other preparations for abdominal surgery may require:
- Pre Anaesthetic checkup (PAC)
- Stop taking blood-thinning medications for 5-7 days before the surgery
- Not to eat or drink anything atleast6-8 hours before the surgery
- Follow the doctor’s instructions for bowel preparation
- Avoid wearing jewelry to the hospital
- Keep all your documents and reports well-organized
- Arrange for help at home because post-surgery, your doctor will be restricting some of your activities.
How Uterus Removal Surgery is Performed?
Uterus removal is done after inpatient hospitalization, meaning that one needs to stay in the hospital for two to three days. The surgery begins by administrating general/regional anesthesia. The surgery generally lasts one to three hours. Depending on the conditions and symptoms, your doctor may perform the following different types of uterus removal surgery, including:
Total Hysterectomy: This is one of the most common types of uterus removal surgery. In this procedure, the surgeon removes the entire uterus and the cervix (neck of the womb) with or without the removal of tubes and ovaries.
Partial Hysterectomy: During a partial hysterectomy, the surgeon removes only the main portion of the uterus and may leave the cervix intact. This is not routinely performed.
Radical Hysterectomy: In this type of uterus removal surgery, the doctor removes the womb and the surrounding tissues and organs, including the ovaries, fallopian tubes, parametrium, lymph glands, fatty tissues, and part of the vagina. This is usually performed in cancer patients.
During surgery, your doctor may also remove your fallopian tubes and ovaries (salpingo-oophorectomy ). This leads to surgical menopause. Discuss with your doctor ahead of time if you need this.
How is the route of surgery decided?
That said, there are several different surgical approaches to perform hysterectomy surgery. Your doctor will suggest you the best technique as per your clinical condition. The techniques include:
Abdominal Hysterectomy- A horizontal bikini-line incision, which lies about an inch above your pubic bone, or a vertical incision may be given on the abdomen depending on the reason for surgery and the condition of the patient. The surgeon then removes the uterus and stitches the incision.
Laparoscopic Hysterectomy: During a laparoscopic hysterectomy, the surgeon makes small incisions in the abdomen and inserts a laparoscope, a long, thin tube with a light and camera attached at the top. Surgery is completed through special instruments using these small cuts (usually 3-5 mm ).
Robotic Hysterectomy: Da Vinci Robot is used during the surgery by experienced surgeons. Robotic surgery being more precise helps in delicate and complex procedures that may be difficult or impossible with other methods. Often, robotic surgery makes minimally invasive surgery possible.
Vaginal Hysterectomy: During this surgical approach, the surgeon removes the uterus vaginally and sutures back the incision to aid in healing. This procedure generally doesn’t leave any external cuts, meaning there won’t be any visible scars.
Selecting the correct approach to surgery plays a vital role in the success of the surgery and minimizing the complications. Treatment has to be tailored as per the clinical profile of the patient.
Possible Complications
Like any other major surgery, there are some risks associated with uterus removal surgery, including bleeding, infection, and reaction to anesthesia. Other complications may include:
- Blood clots in the legs which may travel to other body parts
- Damage to the urinary bladder, ureter, bowel, or other abdominal structures that may require further repair.
Taking Care of Yourself After Surgery
Once the surgery is over, patients may need to stay in the hospital for one or two days. The stay may be extended in case the patient has a post-operative fever, paralytic ileus, or other concerns. The total recovery from uterus removal surgery usually takes six to eight weeks. Robotic and Laparoscopic surgeries usually have lesser bleeding, less post-op pain and discomfort, and faster return to normal activities.
After the surgery, one may feel some soreness, itching, and pain at the incision site for a few days. The doctor will usually remove the drainage tube from the bladder within 48 hours of the surgery. The patient will be encouraged to get out of bed and go for short walks as soon as possible. The doctor will ask you to come back on the seventh to tenth day after discharge for a dressing change and monitor progress. Apart from this, post-operative care includes:
- Stay physically active as advised by physiotherapist
- Avoid indulging in strenuous physical activities, bending for at least 8-10 weeks
- No sexual intercourse for at least 8-10 weeks after the surgery
- Avoid prolonged cough and constipation
- Keep the incision area clean and dry
- Take vitamin supplements
- Maintain a healthy lifestyle
- Take a lot of water, fruits, and high fiber diet (as advised by a dietician )
- Follow your doctor’s recommendations regarding resuming normal activities
