What is a hysterectomy?
A hysterectomy means removal of the uterus. The fallopian tubes and ovaries can be removed at the same time when necessary. A hysterectomy is the most commonly performed gynaecological major operation.
Types of hysterectomies:
You have had all the relevant tests, weighed up your options and decided that having a hysterectomy is the best solution for you. Now you must come to an agreement with your doctor as to how the operation is to be performed.
The uterus can be removed in one of four ways:
- A big cut on the abdomen (bikini-line or vertical)
- A combination of laparoscopic and vaginal operating
- Total laparoscopic (key hole surgery)
Option 1 is the most commonly used approach to remove the uterus. While it is a safe technique overall, its disadvantages include longer hospital stay (usually 4 to 7 days), longer recovery and longer time to return to work (usually 6 -12 weeks), need for more pain medication and a relatively high rate of wound complications (especially in obese and cancer patients).
A vaginal hysterectomy or a combination of a laparoscopic operation with a vaginal hysterectomy (options 2 and 3) mean the hospital stay and recovery time are shorter and less pain medication is required than with the first option. This technique is often not feasible for patients who are very overweight or who have not had vaginal childbirths. There is also a slightly more increased risk of vaginal prolapse in the future due to the excessive traction force required during vaginal operating.
Option 4 - Total Laparoscopic Hysterectomy (TLH) - is a more recent option. After TLH, if there are no complications, patients are usually discharged from the hospital after 24 hours (sometimes on the same day) and they are able to go back to work usually after two weeks. Sometimes, this could take up to 4 weeks. It usually depends on the individual as we all recover differently. The overall complication rate is one third when compared to the first option, and the need for pain killers is reduced by 90% when compared to a major cut on the abdomen and 50% when compared to a vaginal hysterectomy(VH) or laparoscopic assisted vaginal hysterectomy (LAVH). This technique is often not feasible for patients with a very large uterus. In approximately 5% of patients where a TLH is planned, the operation has to be converted to a laparotomy (a major cut on the abdomen). The reasons for this could be intraoperative complications (which are rare) or extremely difficult surgery where the continuation of a laparoscopic technique would increase the risk of complications. The operation is usually very successful with good patient selection and also depending on the experience of the surgeon.
Mr Abu's personal conversion rate is about 0.5%. If your doctor is recommending an 'open' hysterectomy instead of key-hole approach, do not hesitate to ask him/her to give you his/her reasons for the recommendations. Sometimes, even with a big uterus, keyhole approach may still be very feasible depending on the surgeon's laparoscopic skills and expertise. Do not hesitate to ask for a secnd opinion of you have any doubts at all. Mr Abu has personally been able to successfully and safely perform keyhole hysterectomy on women who where otherwise told that such an operation was not feasible.