A hysterectomy is a major surgical procedure to remove the uterus (womb). It is usually performed to treat ovarian cancer, heavy or very painful menstrual periods, severe pelvic pain, fibroids, endometriosis, adenomyosis or pelvic inflammatory disease.
The uterus is a muscular reproductive organ found only in the female body, roughly the shape and size of upside-down pear. The uterus is responsible for the development of the embryo and fetus during the 9 months of pregnancy. The narrow lower region of the uterus is known as the cervix, which connects the uterus to the vagina.
Around the time of ovulation the uterus builds a thick lining (the endometrium) in preparation to receive a fertilised egg. If the egg is unfertilised, the uterine lining comes away as bleeding. This process is known as menstruation. If the egg is fertilised, the fetus will develop inside the uterus throughout the pregnancy.
A total hysterectomy is where both the uterus and the cervix are removed, however, the ovaries are left untouched. Removal of both the uterus and ovaries is called a hysterectomy with oophorectomy.
A subtotal (or partial) hysterectomy is where the uterus is removed but the cervix remains. In some cases where ovarian cancer is the reason for a hysterectomy, the fallopian tubes may also need to be removed. This is known as a hysterectomy with prophylactic bilateral salpingectomy.
A hysterectomy and bilateral salpingo-oophorectomy is where the uterus, fallopian tubes and ovaries are removed. And finally, a radical hysterectomy is where the uterus, fallopian tubes, ovaries, upper part of the vagina, and adjoining pelvic ligaments and lymph nodes are all removed.
There are several ways that a hysterectomy may be performed. Your urologist will discuss the different options with you.
Abdominal hysterectomy – Incisions are made horizontally across the lower abdomen vertically down the midline of the abdomen. The main advantage of this procedure is a lower chance of damaging the urinary tract and surrounding blood vessels. An abdominal hysterectomy is necessary when extensive investigation of the region is required, such as in the case of ovarian cancer.
Laparoscopic hysterectomy – The procedure may also be performed laparoscopically. This is where small incisions are made in the navel through which a small telescope and other small instruments are inserted. The uterus (and other organs, if required) is then removed through the vagina. This procedure may also be performed robotically.
Vaginal hysterectomy – This involves making an incision in at the top of the vagina then removing the uterus through the vagina. A vaginal hysterectomy may be recommended when a woman has large fibroids or cancer.
Both laparoscopic and vaginal procedures are more favourable than a open surgery as there is minimal scarring and a shorter stay in hospital is required.
Following surgery, women are taken to recovery where their vital signs are monitored closely. Some abdominal pain and discomfort may be experienced. Some vaginal bleeding is also common, however this should subside after a day or two.
During recovery patients are encouraged to get up and walk around to help decrease the chance of blood clots forming, or a lung infection. A catheter is also commonly placed in the urethra to help drain urine. This will be removed after 24 hours.
Depending on the kind of surgery, patients will be required to stay in hospital for no longer than a week at most. An uncomplicated abdominal hysterectomy generally requires as stay of two to four days, laparoscopic or vaginal surgery will require a stay of two or three days.
Overall, full recovery will take six to eight weeks. Women should avoid any heavy lifting during this time. Sexual intercourse is also discouraged. However, progressive light exercise is encouraged to help with recovery.
After a hysterectomy women will no longer be able to have children, and will no longer need contraception or experience menstruation. If your ovaries were removed, menopause symptoms may appear within a few days of surgery.
A hysterectomy can be a very affecting procedure. You can discuss with your doctor what will happen to your body and how it may impact your life. Depending on your age you may need oestrogen supplements. If your hysterectomy was to treat cancer, you will need to have regular check ups to make sure the cancer is completely gone.
Overall, a hysterectomy can have many positive outcomes, alleviating many debilitating issues that may have caused much distress previously.
As with any major surgery there are some potential risks involved including infection and internal bleeding, blood clots, difficulty urinating and injury to the surrounding organs. However, these complications are uncommon.
Side effects include decreased sexual desire due to the nature of the surgery, or sometimes increased sexual desire due to alleviation of debilitating symptoms. Psychological side effects – feelings of grief or loss – can also arise. Counselling is recommended for women experiencing these feelings.
Dr Arianayagam is a highly skilled laparoscopic surgeon. After initial training in General Surgery at Royal North Shore Hospital, urology training began in 2006 at Port Macquarie Hospital, Westmead and then Prince of Wales Hospital. During this time Dr Arianayagam trained under Professor Howard Lau at Westmead.
While completing his Urologic Oncology fellowship at the University of Miami Miller School of Medicine there was also significant exposure to more laparoscopic surgery and it was during this time that Dr Arianayagam also honed his skills in teaching.
Currently, Dr Arianayagam has been practicing in Sydney since 2011 and has developed the reputation of being a skilled laparoscopic surgeon and excellent teacher. He routinely performs the entire breadth of urological surgery, including all types of hysterectomy.
If you have any further questions about a procedure or would like to book an appointment, please feel free to call today.