Let’s talk about hysterectomy.
Basically, the indication to do surgery is when non-surgical remedies fail to take care of the problem.
Some of the indications to do hysterectomy include:
- Heavy bleeding
- Irregular vaginal bleeding
- Post menopausal vaginal bleeding
- Painful periods
- Pelvic pain
- Pain with sex
- Uterine prolapse
- Uterine fibroids
- Pre-cancerous changes or cancer
There are different techniques of doing a hysterectomy and each of them has its advantages and disadvantages . In each case a circular incision is made around the cervix at the very top of the vagina so the cervix and uterus can be removed completely. With rare exception, they all have this incision.
Let’s briefly talk about five methods of hysterectomy:
1. Vaginal hysterectomy
This technique involves no incision on the tummy. All of the work is done through the top of the vagina and the uterus is removed from this direction.
2. Abdominal hysterectomy
This technique involves a 20 cm incision, either a bikini cut or an incision from the top of your underwear line to the bellybutton.
3. Laparoscopic assisted hysterectomy
Two or three 5mm incisions are made in the tummy. The advantage is the anatomy can be loosened from above so it could be removed from below. In this technique the incisions usually can be hidden, one in the belly button and the other two are underneath the bikini line and therefore it has the advantage of being more cosmetically appealing.
4. Robotic assisted hysterectomy
During this procedure usually five 8mm incisions are made in the mid and upper abdomen. The incisions are all exposed and less cosmetically appealing. The operator is facing away from the patient across the room and sits with his head in a console with hand and foot controls moving the surgical instruments.
The advantage of this technique is it allows the operator three dimensional visualization and more adaptability if there are a lot of adhesions present. Further, it may reduce the likelihood of the operation finishing with a 20 cm incision and, therefore, saving the patient one extra day of hospitalization.
5. Radical hysterectomy
This is a hysterectomy done when there is invasive cancer present. In this technique lymph nodes are removed and, presently, this technique is not performed in the Permian Basin. Therefore, these cases are referred out to gynecological cancer specialists.