April 20, 2011 [MACAYAN, JELLOU RAY M.

Hysterectomy
Definition: A hysterectomy is an operation to remove a woman's uterus.
Types of Hysterectomy

Depending on the reason for the hysterectomy, a surgeon may choose to remove all or only part of the uterus.
Patients and health care providers sometimes use these terms inexactly, so it is important to clarify if the cervix
and/or ovaries are removed:

 In a supracervial or subtotal hysterectomy, a surgeon removes only the upper part of the uterus, keeping
the cervix in place.
 A total hysterectomy removes the whole uterus and cervix.
 In a radical hysterectomy, a surgeon removes the whole uterus, tissue on the sides of the uterus, the
cervix, and the top part of the vagina. Radical hysterectomy is generally only done when cancer is present.

Surgical Techniques for Hysterectomy

Surgeons use different approaches for hysterectomy, depending on the surgeon’s experience, the reason for the
hysterectomy, and a woman's overall health. The hysterectomy technique will partly determine healing time and
the kind of scar, if any, that remains after the operation.
There are two approaches to surgery – a traditional or open surgery and surgery using a minimally invasive
procedure or MIP.
 
Open Surgery Hysterectomy

An abdominal hysterectomy is an open surgery. This is the most common approach to hysterectomy, accounting
for about 70% of all procedures.
To perform an abdominal hysterectomy, a surgeon makes a 5 to 7 inch incision, either up-and-down or side-to-
side, across the belly. The surgeon then removes the uterus through this incision.
On average, a woman spends more than three days in the hospital following an abdominal hysterectomy. There is
also, after healing, a visible scar at the location of the incision.
MIP Hysterectomy

There are several approaches that can be used for an MIP hysterectomy:

 Vaginal hysterectomy: The surgeon makes a cut in the vagina and removes the uterus through this
incision. The incision is closed, leaving no visible scar. 
 Laparoscopic hysterectomy: This surgery is done using a laparoscope, which is a tube with a lighted
camera, and surgical tools inserted through several small cuts made in the belly. The surgeon performs the
hysterectomy from outside the body, viewing the operation on a video screen. 
 Laparoscopic-assisted vaginal hysterectomy: Using laparoscopic surgical tools, a surgeon removes the
uterus through an incision in the vagina. 
 Robot-assisted laparoscopic hysterectomy: This procedure is similar to a laparoscopic hysterectomy, but
the surgeon controls a sophisticated robotic system of surgical tools from outside the body. Advanced technology
allows the surgeon to use natural wrist movements and view the hysterectomy on a three-dimensional screen.
 April 20, 2011 [MACAYAN, JELLOU RAY M.]

Anatomy and Physiology

 Vagina: A muscular passageway that leads from the vulva (external genitalia)
to the cervix.
 Cervix: A small hole at the end of the vagina through which sperm passes
 into the uterus. Also serves as a protective barrier for the uterus. During childbirth, the cervix
dilates (widens) to permit the baby to descend from pregnancy. During childbirth, the uterine muscles
contract to push out the baby. Each month, unless a fetus has been conceived, the uterine wall sheds its
lining
 Ovaries: Two organs that produce hormones and store eggs. Each ovary
releases one egg per month.
 Fallopian tubes: Muscular tubes that eggs released from the ovaries must
traverse to reach the uterus