Hysterectomy



Definitions

What conditions are hysterectomies done for?

Total Laparoscopic Hysterectomy

Risks of hysterectomy

Should the ovaries also be removed?


Hysterectomy and / or  removal of ovaries

At Sunshine Coast Advanced Laparoscopic Surgery, Dr Orford performs hysterectomy totally laparoscopically, with the goal being,to obtain the best recovery and outcomes.

Definitions:

Hysterectomy is the surgical removal of the uterus.

Total hysterectomy means removal of the uterus and cervix (part of the uterus) but not the ovaries.

Subtotal hysterectomy refers to the removal of the body of the uterus but not the cervix, nor the ovaries.

Salpingectomy means removal of the fallopian tube.

Oophorectomy means removal of the ovary.

So the traditional operation of abdominal hysterectomy (through an incision in the abdomen) is called either:

TAH - total abdominal hysterectomy, or

TAHBSO - total abdominal hysterectomy , bilateral (both) salpingo-oophorectomy (removal tubes and ovaries)

Other methods of hysterectomy include:

VH - vaginal hysterectomy (usually without removing ovaries), meaning the surgery is all performed through the vaginal opening.

As laparoscopic surgery has improved over the last 20 years or so new methods developed:

LAVH - Laparoscopic Assisted Vaginal Hysterectomy - some of the surgery is performed through the laparoscope, but most still done vaginally.

TLH - Total Laparoscopic Hysterectomy - the entire operation is performed laparoscopically

What conditions are hysterectomies done for?

There are a range of symptoms and conditions for which women elect to undergo hysterectomy.
Most are to do with quality of life, and are done for symptoms such as:

Usually non surgical treatments are used first, hopefully avoiding the need for surgery at all.

Sometimes hysterectomy is required for life threatening conditions such as cancer of the uterus, cervix, or ovaries. These procedures are usually performed by Gynaecological Oncologists (subspecialists in womens cancer) as more radical / invasive surgery is sometimes required, including lymph node sampling, removal of bowel or omentum.

Technique of TLH:

Advantages of TLH compared to "open" abdominal hysterectomy

Proposed advantages / disadvantages of TLH over VH

Risks of hysterectomy

Should the ovaries also be removed?

The main reason this is discussed is to reduce heavily (but not remove) the risk of ovarian cancer. Ovarian cancer is a frightening topic for women as it is difficult to detect early and often diagnosed late in its course, with limited chances of complete cure.

Whilst it is nice to almost remove this risk, we must consider any harmful effects of removing healthy ovaries.

Clearly in women who are still cycling / pre-menopausal, removal of the ovaries will create a sudden and complete menopause. They often experience worse symtoms than those whose ovarian hormones gradually decrease. They are exposed to the health risks of menopause earlier - namely osteoporosis, heart disease, maybe worsening of pelvic floor / bladder symptoms.

If HRT is then required earlier, and for longer then she may be more at risk of breast cancer and DVTs.

Overall it has been estimated that to remove a young woman’s ovaries (certainly if they are pre-menopausal, some studies suggest up to age 65), the net effect is to slightly shorten her life expectancy.

Obviously each woman is different, and factors like family history of ovarian or breast cancer may alter the risk : benefit ratio, as may an existing diagnosis of breast cancer.