When to perform a hysterectomy or removal of the uterus

Hysterectomy: what it is

A hysterectomy is the surgical removal of the uterus (or womb). The uterus is a muscular organ with a cavity inside it called the uterine cavity. Its function is to house the baby and allow it to grow during pregnancy. The uterus has two parts: an upper part or uterine body, where the uterine cavity is located; and a lower part or cervix. The hysterectomy can be total, removing both parts; or sub-total, in case of removing only the uterine body.

Pathologies or gynecological problems that require a hysterectomy

The main reasons for performing a hysterectomy include:
– Uterine fibroids: these are benign nodular formations but can cause chronic pain and very heavy menstrual bleeding.
– Excessive menstrual bleeding leading to repeated anemia that does not respond to hormonal treatment.
– Severe endometriosis: is a benign and self-limiting disease with menopause, but in severe cases of chronic pain, may require removal of the uterus.
– Uterine prolapse: means the descent of the uterus through the vagina, which usually causes vaginal heaviness and recurrent infections.
– Cervical cancer
– Cancer of the uterine corpus uteri, most frequently of the endometrium.
– Ovarian cancer

Techniques for performing hysterectomy and when to choose them

Hysterectomy can be performed in three ways:
– Vaginal, in case of uterine prolapse.
– Abdominal, through a large incision that can be transverse (like a cesarean section) or longitudinal, for very exceptional cases of very large uteri (for multiple fibroids or advanced ovarian cancer).
– Laparoscopic: it is a mini-invasive surgical technique. Today, experienced gynecological surgeons perform almost 95% of hysterectomies using the laparoscopic approach.

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What does mini-invasive laparoscopic hysterectomy consist of?

The mini-invasive laparoscopic hysterectomy consists of removing the uterus through a 10 mm incision in the navel, through which a camera is introduced that allows viewing through an external monitor; and three 5 mm incisions underneath in the pelvis, through which the material is introduced to perform the procedure.

The abdominal cavity is previously distended with a gas which is extracted at the end of the intervention. The uterus, once uninserted from its anchor points, is extracted vaginally, closing the roof of the vagina with stitches, and ending the operation. Under normal conditions it usually lasts around 45-60 minutes. Patients usually have a very fast and effective recovery in the vast majority of cases thanks to the minimal surgical invasiveness. Thus, they can be discharged the same day or the next day, eating, walking, urinating on their own and tolerating pain with a simple oral analgesic.

Patient’s postoperative hysterectomy routine

The patient can go about her normal life after the operation, as much as her pain level allows. This includes any type of daily activity such as lifting light objects, walking both inside and outside the house, going up and down stairs, or eating all kinds of food, preferably not fried and in small quantities, spread over several meals.

Also, depending on the type of work she does, she can return to work as soon as the patient wishes, as long as she feels comfortable with her level of pain. On the other hand, she can drive a car again once she feels confident to quickly operate the pedals and is not taking any medications that alter consciousness or sleep. The only formal limit to laparoscopic hysterectomy is abstinence from sex for 40 days. This is always recommended to avoid opening the sutured roof of the vagina during the procedure.