Hysterectomy
What is a hysterectomy?
A hysterectomy is the removal of the uterus. This is a definitive procedure. Removing the uterus means that women can no longer be pregnant. It is one of the most common surgical procedure for women.
Why should a hysterectomy be done?
There can be many reasons why a woman would need a hysterectomy:
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Fibroids
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Abnormal menstrual bleeding
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Pelvic pain
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Prolapse
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Gynecologic cancer
What are the different types of hysterectomy?
Depending on why a woman would need a hysterectomy, there are different options of hysterectomy. In cases where there is no cancer or pre-cancerous changes, there are two options available: a total hysterectomy or a partial/supracervical hysterectomy.
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Total hysterectomy: this is the removal of the uterus AND cervix.
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Partial or supracervical hysterectomy: this is the removal of the uterus ONLY. The cervix is left intact.
You should discuss which option is best suited for you with your doctor.
What other organs might be removed during a hysterectomy?
We recommend that your fallopian tubes be removed at the time of hysterectomy. This is called a salpingectomy. Recent research has shown that some forms of ovarian cancer start at the ends of the tubes. Once the uterus is removed, the fallopian tubes have no physiologic function. By removing the tubes, your risk of cancer is reduced.
Depending on your medical history, we may recommend removing your ovaries. This is called an oophorectomy (or salpingo-oophorectomy if the fallopian tubes are also removed). In some women, this may result in menopausal symptoms and you can discuss with your doctor to see if hormone replacement therapy is an option.
What are the surgical approaches to hysterectomy?
There are three ways to perform a hysterectomy: laparotomy (large abdominal incision), laparoscopy (small abdominal incisions) and vaginally (vaginal incisions). Each has its own benefits and risks. Minimally invasive surgeries, like laparoscopy and vaginal procedures, have been shown to have superior outcomes. Studies have shown quicker return to activity, fewer surgical complications, reduced infection rates, and less postoperative pain.
At the Toronto MIGS Centre, we specialize in complex laparoscopic and vaginal hysterectomies. Talk to your doctor to see which procedure is the safest for you.
HOW IS A LAPAROSCOPIC HYSTERECTOMY DONE?
Laparoscopic surgery requires 4 to 5 small incisions on the abdomen (1 cm or less in size). The abdomen is inflated with carbon dioxide gas to allow for visualization. A telescope, called a laparoscope, is inserted into the abdomen through one of the incision to allow the surgeon to see. Using long instruments placed through the other incisions, the surgery is performed. The uterus can then be removed in small pieces through the incisions or through the vagina.
HOW IS A VAGINAL HYSTERECTOMY DONE?
For a vaginal hysterectomy, there are no abdominal incisions. The uterus is removed through the vagina. Not all women can have a vaginal hysterectomy. Women with adhesions (scarring in the abdomen from previous surgery or infections) and women with a large uterus may not qualify for vaginal hysterectomy.
What are the risks of a hysterectomy?
While generally the risks of complications are low, these are the more common risks. Depending on your medical and surgical history, the risks of complications will vary.
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Bleeding requiring blood transfusions
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Infections
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Injury to surrounding organs (bowel, bladder, ureters, blood vessels and nerves)
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Venous thromboembolism
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Conversion from laparoscopy or vaginal surgery to laparotomy