Abdominal Hysterectomy and Other Types: Causes, Risks and Techniques

It is a medical procedure that removes the uterus through an incision in the lower abdomen.

The uterus – or womb – is where the baby grows if the woman is pregnant. A partial hysterectomy removes only the uterus, leaving the cervix intact. A total hysterectomy removes the uterus and cervix.

A hysterectomy can also be done through a laparoscopic or robotic surgical approach – which uses long, thin instruments that pass through small abdominal incisions.

An abdominal hysterectomy may be recommended over other types of hysterectomy if:

  • The woman has a large uterus.
  • Your doctor wants to check other pelvic organs for signs of the disease.
  • Your surgeon concludes that an abdominal hysterectomy is necessary.

Why is Abdominal Hysterectomy performed?

You may need a hysterectomy to treat:

Fibromas A hysterectomy is the only safe, permanent solution for uterine fibroids that often cause benign tumor tumors depending on the level of discomfort and the size of the tumor.

The endometriosis . In endometriosis, it grows outside the uterus in the ovaries. When the medication or conservative surgery does not improve along with the removal of the ovaries and fallopian tubes.

Uterine prolapse . Uterine prolapse can lead to urinary incontinence, pressure in the pelvis, or difficulty defecating. A hysterectomy may be necessary to treat these conditions.

Abnormal vaginal bleeding . If the periods are heavy, irregular or prolonged each cycle, a hysterectomy can bring relief when the bleeding can not be controlled by other methods.

Chronic pelvic pain . Occasionally, surgery is the last resort necessary for women who experience chronic pelvic pain that arises clearly in the uterus.

However, a hysterectomy does not provide any relief, it can create new problems. Looking for a careful evaluation before proceeding with major surgery is the best alternative.

A hysterectomy ends with the ability to get pregnant. If you think you might want to get pregnant, ask your doctor about alternatives to this surgery. In the case of cancer, it could be the only option.

Risks

This procedure is generally very safe, but with any major surgery comes the risk of complications.

Risks associated with an abdominal hysterectomy include:

  • Blood clots.
  • Infections
  • Excessive bleeding
  • Adverse reaction to anesthesia.

Damage to the urinary tract, bladder, rectum or other pelvic structures, more
advanced of the menopause, even if the ovaries are not removed; on rare occasions, death.

Types of hysterectomy

Depending on the reason for the hysterectomy, a surgeon may choose to remove all or only part of the uterus. Patients and healthcare providers sometimes use these terms inaccurately, so it is important to clarify if the cervix and / or ovaries are removed.

In a supracervial or subtotal hysterectomy, a surgeon removes only the upper part of the uterus, keeping the cervix in place. While a total hysterectomy removes the entire uterus and cervix. In a radical hysterectomy, a surgeon removes the entire uterus, the tissue on the sides of the uterus, the cervix, and the upper part of the vagina. Radical hysterectomy is usually only done when cancer is present.

The ovaries can also be removed – a procedure called oophorectomy – or they can be left in place. When the tubes are removed, it is called a salpingectomy. Therefore, when the entire uterus, both tubes and both ovaries are removed, the entire procedure is called hysterectomy and bilateral salpingectomy-oophorectomy.

Surgical techniques for hysterectomy

Surgeons use different approaches to hysterectomy, depending on the experience of the surgeon, the reason for the hysterectomy and the general health of the woman. The hysterectomy technique will determine in part the healing time and the type of scar, if any, that remains after the operation. There are two approaches to surgery: a traditional or open surgery and surgery with a minimally invasive procedure or MIP.

Open Surgery Hysteroctomy

An abdominal hysterectomy is an open surgery. This is the most common approach to hysterectomy, which accounts for approximately 65% ​​of all procedures. To perform an abdominal hysterectomy, a surgeon makes an incision of 5 to 7 inches, either up and down or side to side, through the belly. The surgeon then removes the uterus through this incision. After an abdominal hysterectomy, a woman usually spends 2-3 days in the hospital. There is also, after healing, a visible scar at the location of the incision.

MIP Hysterectomy

There are several approaches that can be used for a MIP hysterectomy:

Vaginal hysterectomy: The surgeon makes a cut in the vagina and removes the uterus through this incision. The incision is closed, with no visible scar.

Laparoscopic hysterectomy: The surgery is performed using a laparoscope, which is a tube with a lighted camera, and surgical tools inserted through several small cuts made in the abdomen or, in the case of a single-site laparoscopic procedure, navel. The surgeon performs the hysterectomy from outside the body, seeing the operation on a video screen.

Laparoscopic assisted vaginal hysterectomy: Using laparoscopic surgical tools, the surgeon removes the uterus through an incision in the vagina.

Robotic-assisted laparoscopic hysterectomy: This procedure is similar to a laparoscopic hysterectomy. But the surgeon controls a sophisticated robotic system of surgical tools from outside the body. Advanced technology allows the surgeon to use natural movements of the wrist and see the hysterectomy on a three-dimensional screen.

Comparison between MIP Hysterectomy and Abdominal Hysterectomy

The use of an IPM approach to remove the uterus offers a number of benefits compared to the more traditional open surgery used for an abdominal hysterectomy. In general, a MIP allows a faster recovery, shorter hospital stays, less pain and scarring, and a lower likelihood of infection than an abdominal hysterectomy.

With an IPM, women are generally able to resume normal activity in an average of three to four weeks, compared with four to six weeks for an abdominal hysterectomy. And the costs associated with an IPM are considerably lower than the costs associated with open surgery, depending on the instruments used and the time spent in the operating room. Robotic procedures, however, can be much more expensive. There is also less risk of incisional hernias with an IPM.

Not all women are good candidates for a minimally invasive procedure. The presence of scar tissue from previous surgeries, obesity and health status can affect whether or not it is an advisable MIP. You should talk to your doctor about whether you can be a candidate for an IPM.

Other risks of hysterectomy

Most women who undergo a hysterectomy do not have serious problems or complications from surgery. However, hysterectomy is considered major surgery and is not without risks. These complications include:

  • Urinary incontinence
  • Vaginal prolapse (part of the vagina that leaves the body)
  • Fistula formation (an abnormal connection that forms between the vagina and the bladder)
  • Chronic pain

Other risks of hysterectomy include wound infections, blood clots, hemorrhage, and injury to surrounding organs, although these are rare.

What to expect next?

After a hysterectomy, if the ovaries were also eliminated, a woman will enter menopause. If the ovaries were not removed, a woman can enter menopause at a younger age than she would have otherwise.

Most women are told to refrain from sex and avoid lifting heavy objects for six weeks after the hysterectomy. After a hysterectomy, the vast majority of women surveyed feel that the operation was successful in improving or curing their main problem (for example, pain or intense periods).