About 590,000 hysterectomies are done annual in the U.S. but I would say that a vast majority of the patients don't take the time or effort to educate themselves prior to going under the knife. I want to give you some key questions to ask your doc and provide some sound education on the matter. So hopefully if you are ever in the position that you need a hysterectomy you are prepared.
First and foremost, never have surgery without first understanding exactly what will be done. I know of plenty of patients when asked about a past surgical history can not tell me whether they had 1 ovary, both ovaries, or no ovaries removed with their hysterectomy. A hysterectomy by definition is the idea of removing the uterus. Ovaries are considered to be an extra procedure that can be done in conjunction with the hysterectomy. Most patients would say that they had a partial hysterectomy because they didn't have their ovaries removed. This is incorrect. A partial hysterectomy is the idea of leaving the cervix behind. The gynecologist would call this a subtotal or supracervical hysterectomy.
There are a variety of ways to have a hysterectomy done and here are the bullet points
- Total abdominal hysterectomy: this is the original way that a hysterectomy was done. The incision on your abdomen can be either (bikini cut, like a c-section or vertical). Of all of the hysterectomies this is the most painful and will require the most time in the hospital directly after surgery. In general you will be in the hospital for 2-3 days after the surgery (mostly based on how your pain tolerance).
- Vaginal hysterectomy (Gold Standard): This is considered to be the standard by which all others are compared. ANY Gynecologist worth his/her salt should be able to perform a successful vaginal hysterectomy. Most patients will stay overnight in the hospital and be discharged to home the next day. Because the procedure is being done vaginally there won't be any incisions on your abdomen.
- Laparoscopic assisted Vaginal Hysterectomy (LAVH): With the assistance of a laparoscope a portion of the hysterectomy in the abdomen and the remainder is done vaginally. Most patients will stay overnight in the hospital and be discharged to home the next day.
- Total Laparoscopic Hysterectomy (TLH): The entire hysterectomy is done laparoscopically. The uterus is either pulled out vaginally or morcellated (cut into small pieces and pulled out of the abdomen). Most patients will stay overnight in the hospital and be discharged to home the next day.
- daVinci Hysterectomy: This is similar to the TLH but with superior visualization and instrument flexibility. Most patients will stay overnight in the hospital and be discharged to home the next day.
The type of hysterectomy will be based on the size of your uterus (fibroids will make the uterus grow in size and make one type of hysterectomy over the other more difficult), prior surgically history, obesity, and most importantly the skill set of the surgeon.
FIVE Questions you should have answered prior to go into surgery:
- Why is it necessary for me to have a hysterectomy?
- Number one cause is heavy bleeding caused by fibroids
- The presence of fibroids alone (without any symptoms) is not a reason for a hysterectomy
- How do you plan on performing my surgery?
- As of 2013 I would consider it antiquated to have an abdominal hysterectomy under MOST situations. Even a 20 week sized uterus (the top of your uterus can be felt at your belly button) can be safely done with the daVinci system.
- How long will I be off work?
- With a Vaginal hysterectomy, LAVH, TLH, or daVinci you should have the quickest recovery time.
- Will I have my ovaries removed? Why or Why not?
- At one time it was standard procedure to have an oopherectomy done (removal of ovaries) and patient started on hormone replacement therapy right afterwards. I counsel most of my patients to keep their ovaries. Seldom times will I perform the hysterectomy and think that the patient MUST have their ovaries removed.
- What should I call you about after surgery?
- No one wants complications but they do happen. Bleeding, fever, excessive pain would definitely be something I want my patients to call about.
Thanks for reading.
Dr. Harris
