Minimally invasive surgery - Vaginal hysterectomy
Hysterectomy is the surgical removal of part or all of the uterus. It is the second most common major surgery among women of child-bearing age.
Hysterectomy may be done to treat conditions that affect the uterus. Some reasons a hysterectomy may be needed include:
- Uterine fibroids
- Endometriosis
- Pelvic support problems (such as uterine prolapse)
- Abnormal uterine bleeding
- Cancer
- Chronic pelvic pain
A hysterectomy can be:
- Subtotal (also called partial or supracervical), in which the upper part of the uterus is removed but the cervix is left in place
- Total, in which the entire uterus, including the cervix, is removed
- Radical, in which the entire uterus and support structures around the uterus are removed (this is done if certain types of cancer are present)
A hysterectomy does not include removal of the ovaries or the fallopian tubes. When these organs are removed at the same time as the uterus and cervix, the term salpingo-oophorectomy us added to hysterectomy.
Procedure
The type of hysterectomy chosen depends on the reason for the surgery. The procedures available at Women’s Health Associates include the conventional abdominal, vaginal, and laparoscopically-assisted vaginal hysterectomy, as well as the more contemporary approaches such as total laparoscopic, supracervical, and robotically-assisted hysterectomy.
In vaginal hysterectomy, the surgery is done entirely through the vagina. With this type of surgery, you will not have any scars on your abdomen. Because the incision is inside the vagina, the healing time may be shorter than with abdominal surgery. Patients generally leave the hospital in one to two days, and are fully recovered in approximately 4 weeks. Vaginal hysterectomies can be performed under general as well as regional anesthesia (spinal or epidural).
The vagina is held open with retractors and an incision is performed around the cervix. The dissection is then continued upwards until the entire uterus is released from its attachments and then removed through the vagina. Due to the nature of the approach, the cervix is always removed during this type of hysterectomy. The ovaries are not always accessible from this approach, so patients who wish to have their ovaries removed may not be candidates for vaginal hysterectomy. Other conditions that are not generally appropriate for vaginal hysterectomy include:
- Extremely large fibroid uterus (moderately sized fibroids can often be removed vaginally)
- Cancer of the uterus or ovaries
- Pelvic pain due to extensive endometriosis or scarring
- Uterus that is supported very high in the pelvis, especially with a narrow vagina