Hysterectomy surgeries are called Hysterectomy in traditional medical literature. It is the surgery to completely remove the uterus from the body.
Hysterectomy is performed for different reasons and with different methods. You can find the conditions that require hysterectomy and the surgical methods that can be preferred in this article.
It is the surgery to remove the uterus (uterus) from the abdomen or vaginally. The hysterectomy surgery to be performed from the abdomen is performed as an open surgery by making an incision in the abdomen, and laparoscopic or robotic surgery is performed through 5 to 10 mm holes. If the vaginal method is preferred for hysterectomy, it is called vaginal hysterectomy.
Hysterectomy surgery can be performed under general anesthesia in the operating room while the patient is asleep or under epidural anesthesia from the waist while the patient is awake. If open surgery is to be performed, epidural is preferred, if the surgery is to be performed with laparoscopy, general anesthesia is preferred.
The main purpose is to separate the uterus from the bladder in the front neighborhood, from the rectum in the back neighborhood, and to separate it from the vagina after the vessels feeding the uterus and the ligaments holding the uterus are tied. After the uterus is separated from the vagina, a stump is created with stitches to be placed at the end of the vagina. The uterus is removed laparoscopically from the abdomen in open surgeries or vaginally in closed surgeries.
If hysterectomy is performed for gynecological cancers, it can be performed as a radical hysterectomy, where the uterus is removed more extensively, or it can be performed together with salpingo-oophorectomy surgeries, where the tubes and ovaries are removed on both sides.
There are 3 basic methods in hysterectomy surgeries,
The first option in hysterectomy surgery should always be the vaginal route. This option, called vaginal hysterectomy, has a faster recovery and fewer complications because there is no incision in the abdomen, but it may not be suitable for every patient. In order for this method to be applied, the patient's uterus must have sagged into or outside the vagina (prolapse).
If the degree of sagging is too much, pelvic floor surgeries (sacrospinous fixation, sacrocolpopexy) where the stump is hung to the hip bone after the uterus is removed can be added to the surgery. You can visit our relevant pages for prolapse (uterine sagging) surgeries.
The basic approach for patients who cannot have vaginal hysterectomy is to perform the surgery from the abdomen.
The classical method in the abdominal approach to surgery is to perform the surgery with an open incision. The incision to be made in the abdomen can be made horizontally in the groin area, similar to a cesarean incision, or vertically from the navel to the groin.
The uterus, whose veins and ligaments are cut and tied, is separated from the vagina and removed from the abdomen, and the vaginal stump is closed. This procedure is called total abdominal hysterectomy in medical terms. Then, the abdominal layers are anatomically closed and the procedure is completed. If the cervix, called the cervix, is left in the surgery, it is called Supracervical or subtotal hysterectomy.
The recommended method for removing the uterus in modern surgical methods is laparoscopic or robotic hysterectomy, which is performed with the help of 5 or 8 mm trocars placed in the abdomen.
Initially, laparoscopy (closed surgery) was used to correct the distorted anatomy by entering the abdominal cavity and to facilitate the surgery before vaginal hysterectomy (vaginal uterus removal) surgeries.
Today, it is used to evaluate the feasibility of vaginal hysterectomy in a uterus with intra-abdominal adhesions, endometriosis, or large myoma, or to perform a part or all of the surgery laparoscopically.
Although the basic techniques have been standardized for all 3 methods, there are ongoing discussions on the advantages, risks and when to use each technique.
LAVH is the most commonly used and fastest spreading method among the three techniques. It is technically easier to learn and apply than the others.
Three or four entry techniques are used to observe the intra-abdominal membranes (peritoneum),and any adhesions are separated. The arteries that feed the ovaries (in surgeries where the ovaries are removed) or between the ovaries and the uterus (in surgeries where the ovaries are preserved) are tied and cut.
The ligaments that connect the uterus to the anterior abdominal wall are cut. The uterus and bladder are separated from each other. At this stage, the main arteries of the uterus can be cut laparoscopically, or the surgeon may prefer to switch to vaginal surgery at this stage and perform the surgery vaginally.
