Types of hysterectomy

02 Feb Types of hysterectomy

If you are considering a hysterectomy, you may have come across a few different terms used to describe this surgery. A hysterectomy is the surgical removal of uterus. While many women think that hysterectomy includes the removal of ovaries too, leading to menopause, this is not the case. Removal of the ovaries is named OOPHORECTOMY.

The different terminologies associated with hysterectomy can be confusing, but they can be broadly divided into what is removed and how is it removed.

What is removed?

A TOTAL HYSTERECTOMY is the most common form of hysterectomy and involves removal of the uterus including the cervix (the part of the uterus that connects to the vagina).

If the cervix is retained, this is called a SUBTOTAL HYSTERECTOMY.

DIFFERENCE BETWEEN A SUBTOTAL AND TOTAL HYSTERECTOMY

There is no difference between the rate of prolapse or sexual dysfunction following either type of hysterectomy. The disadvantage of retaining the cervix is the need for pap tests (cervical cancer screening) to be continued after hysterectomy and, a chance that periods may continue. Women who undergo a total hysterectomy no longer need pap tests if they were previously normal and will completely stop having periods.

Most hysterectomies performed for benign conditions do not involve removing the ovaries. As such, a hysterectomy does not lead to menopause. The fallopian tubes are usually removed when a hysterectomy is performed because they have no hormonal function and most ovarian cancers arise from the tubes. Removal of the fallopian tubes is termed a SALPINGECTOMY. Removing the tubes reduces the risk of ovarian cancer.

Some early cervical cancer may be treated with a RADICAL hysterectomy, where the uterus, cervix, parametrium (tissue surrounding cervix and vagina) and upper vagina is removed. This is much more complex procedure with higher morbidity only reserved for cancers.

How is it removed?

ABDOMINAL hysterectomy is done through a large incision in the abdomen, also termed OPEN hysterectomy. This is often reserved for a very large uterus or cancer.

LAPAROSCOPIC or KEYHOLE hysterectomy (with or without the help of ROBOTIC instruments) is performed through ‘keyhole’ incisions in the abdomen leading to lower levels of pain, bleeding and infection rates. This in turn results in a quicker recovery.

Almost all benign hysterectomies can be performed through this technique, even in extremely overweight women or in women with a very large uterus, as long as the gynaecologist is specifically trained in this and performs this technique in high volume.

The uterus may also be removed through the vagina, this technique is termed a VAGINAL hysterectomy. Vaginal hysterectomy is normally performed for uterine prolapse.

Questions to ask your gynaecologist

If you have been recommended for a hysterectomy, some questions you may wish to ask your gynaecologist are:

• Why is a hysterectomy recommended?
• What will be removed?
• Why a particular method of hysterectomy is chosen?
• Is it possible to utilise a minimally invasive approach such as laparoscopic or robotic hysterectomy?
• How often do you perform a hysterectomy?

While all major surgeries may be associated with risks and potential complications, gynaecologists that perform this type of surgery regularly and in high volume are associated with fewer complications. Being overweight or having a large uterus is also not an absolute contraindication to minimally invasive hysterectomy.