What does a hysterectomy involve?
Q. What does a hysterectomy involve and are there alternatives?
A. Hysterectomy, the surgical removal of a woman’s uterus, is the second most common surgery among women in the United States after caesarean section - one in three women can expect to have one by age 60.
There are several conditions for which a hysterectomy is performed, including cancer, fibroids, endometriosis, and abnormal vaginal bleeding or pain. The extent of the hysterectomy will depend on the specific condition. A total hysterectomy removes the whole uterus and cervix. A subtotal or partial hysterectomy removes only the upper part of the uterus, keeping the cervix in place. In both cases, a surgeon may also remove the ovaries and fallopian tubes. Some cases of cancer are treated with a radical hysterectomy, which removes the uterus, cervix and adjacent tissue, and upper part of the vagina.
Hysterectomies have traditionally been performed as an open abdominal surgery. But Hye-Chun Hur, head of minimally invasive gynecologic surgery at Beth Israel Deaconess Medical Center, says that alternatives to this approach now exist. They include nonsurgical treatments for some of the conditions typically treated with hysterectomy, as well as surgical interventions that are less severe. Women with fibroids, for instance, may have them surgically removed while sparing the uterus, or can have a procedure in which the arteries feeding the fibroids are destroyed.
For those women who are advised to have a hysterectomy, there are also less invasive ways of doing the procedure. Hur says that these newer types of procedures have led to dramatically shorter recovery times (in some cases, the recovery time is a matter of days, rather than several weeks for abdominal surgery). Some procedures are performed through an incision in the vagina, rather than the abdomen. Others are done laparoscopically, requiring only small incisions in the abdomen and sometimes the vagina. Not all patients are good candidates for minimally invasive procedures, depending on their medical condition, its severity, and their health status. Laparoscopic procedures do carry risks and require specialized surgical training. Hur says it’s important to have a discussion with your doctor about the best treatment course.
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