Hysterectomy (removal of the uterus, uterine excision) is one of the most common procedures in gynecology. For some conditions, there are alternatives to this surgery. Uterine cancer, however, usually requires a radical removal of the uterus (total hysterectomy). Here you will find further information as well as a selection of specialists and centers to help you learn about the pros and cons, alternative treatment options, and potential complications.
A hysterectomy (removal of the uterus) is one of the most common gynecological procedures. Reasons for the procedure include benign conditions such as fibroids, bleeding disorders, or endometriosis, as well as malignant tumors such as uterine cancer. Depending on the findings, the procedure is performed abdominally, vaginally, or using a minimally invasive (laparoscopic) approach. A complete hysterectomy includes removal of the uterine body and cervix; in cases of cancer, it often also includes the ovaries and lymph nodes. Consequences include the loss of fertility and—depending on the extent of the procedure—the cessation of menstruation. Specialists in gynecology and obstetrics perform the procedure.
The procedure is performed for both benign and malignant gynecological conditions. The most common reasons for this surgery are
Location and size of the uterus in the female body © SciePro | AdobeStock
Most fibroids do not generally require surgery unless they cause symptoms. These symptoms include
If you experience pain in the pelvis or lower abdomen, the cause must first be accurately determined. Before surgery, it must be determined whether the cause can be resolved through this approach.
A hysterectomy is not always necessary. For example, in the case of uterine fibroids, there are also uterine-preserving treatments available, including
It is not uncommon for women to face the choice of living with mild pain and minor problems or having their uterus removed. Before deciding on a radical (total) hysterectomy, patients should seek detailed advice from their gynecologist and obstetrician.
The choice of surgical approach depends on the reasons for the hysterectomy.
One option is a subtotal hysterectomy (also known as a supracervical hysterectomy). In this procedure, only the body of the uterus is removed, so that the cervix is preserved.
In a total hysterectomy, the cervix is also removed, meaning the entire body and cervix of the uterus are excised. This type of hysterectomy is the most common.
A radical hysterectomy goes even further and is performed in cases of uterine cancer. In this procedure, the
In many cases of malignant cancer, it is also necessary to remove the lymph nodes in the pelvis and along the abdominal aorta. In addition, the ovaries and fallopian tubes often must be removed as well. Whether this is advisable for benign conditions must be decided on a case-by-case basis.
Depending on the surgical approach, there are four different methods for the surgical removal of the uterus:
The surgical approach chosen by the gynecologist depends, among other factors, on the condition and the size of the uterus. The gynecologist also discusses this decision with the patient.
An abdominal hysterectomy is the removal of the uterus through an incision in the abdominal wall. The advantage of this approach lies in
In the past, abdominal hysterectomy was performed more frequently. Today, however, efforts are made to avoid an abdominal incision by using one of the following methods, as these are less invasive and allow the patient to leave the hospital a few days after the procedure.
The anatomy of the uterus © bilderzwerg | AdobeStock
In a vaginal hysterectomy, the uterus is removed through the vagina. This is possible if the uterus is not too large. The advantages of this method are
Nowadays, laparoscopically assisted hysterectomy (LAVH) is increasingly performed for non-malignant conditions. This method combines laparoscopy with a vaginal approach. It requires only small incisions in the abdominal wall.
A total laparoscopic hysterectomy (TLH) involves the removal of the entire uterus via laparoscopy. A laparoscopic supracervical hysterectomy (LASH) is also an option; in this procedure, the cervix remains in the body.
Overall, the proportion of subtotal hysterectomies performed for benign conditions is increasing worldwide. Disadvantages include the fact that, postoperatively, persistent cyclic bleeding must be expected in up to 20% of cases, and secondary removal of the cervix in 2–5% of cases.
One advantage is a slightly faster recovery from the procedure. Occasionally cited presumed benefits, such as
have never been proven.
One of the primary long-term consequences of a hysterectomy is the loss of fertility. Pregnancy is no longer possible; therefore, any desire to have children should be discussed before the surgical procedure.
If the cervix and ovaries were removed in addition to the uterine body, menstrual bleeding will also cease.
If you have any questions or need assistance regarding the topic above, please consult a doctor.
Specialists in obstetrics and gynecology are trained to perform a hysterectomy.
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