Hysterectomy

About Hysterectomy

Hysterectomy is the surgical removal of the uterus and is one of the most common major gynecologic operations. Common indications include uterine fibroids, abnormal uterine bleeding, endometriosis and adenomyosis, uterine prolapse, chronic pelvic pain and cancers of the uterus, cervix or ovaries. A total hysterectomy removes the uterus and cervix, a supracervical or subtotal hysterectomy leaves the cervix in place, and a radical hysterectomy, developed by the Austrian gynecologist Ernst Wertheim for cervical cancer, also removes the surrounding tissue called the parametrium, the upper vagina and pelvic lymph nodes. The operation can be performed abdominally through an incision, vaginally without an abdominal incision, or by laparoscopic or robotic approaches. Professional bodies generally favor vaginal or laparoscopic routes when feasible because they are associated with faster recovery than open surgery. The fallopian tubes are now often removed at the same time because many ovarian cancers are thought to begin there. Removal of the ovaries may be performed for cancer risk reduction in carriers of BRCA mutations or for specific disease; removal before natural menopause causes surgical menopause and has been associated with increased cardiovascular and bone health risks, so ovarian conservation is often considered when appropriate. Complications include bleeding, infection, injury to the bladder, ureters or bowel, and separation of the vaginal cuff. Hysterectomy ends menstruation and the ability to carry a pregnancy.