Hysterectomy

The uterus is located in the abdominal cavity and its removal - hysterectomy is performed if:

• Large uterine fibroids (myomas or leiomyomas).
  
• Irregular and uncontrolled heavy bleeding during menstruation and outside the menstrual cycle.
• Pelvic pain in endometriosis (if a endometrial-like tissue grows outside your uterus).
• In endometrial diseases (polyps, abnormalities and tumors of the endometrium).
• Uterine prolapse (uterus descends into the vaginal canal).
• Oncological diseases of the cervix, uterus, ovaries and endometrium.

Currently, there are several surgical approaches:

• Abdominal hysterectomy - classic approach through the abdomen into the abdominal cavity. It is performed through an incision in the lower abdomen, from which the uterus is removed.
• Vaginal hysterectomy - surgery and removal of the uterus is performed from access through the vagina.
• Laparoscopically assisted vaginal hysterectomy (LAVH) - combines the advantages of laparoscopy (release of the uterine lining) and vaginal surgery (removal of the uterus).
• Robotic-Assisted Laparoscopic Hysterectomy - similar to LAVH with the help of robotic instruments.

We also distinguish several types of operations according to their extent: 

• Total hysterectomy - removal of the entire uterus (neck and body of the uterus, including the cervix).
• Partial (subtotal or supracervical) hysterectomy, in which the cervix is ​​left.
• Radical hysterectomy with the removal of the cervix and uterus, as well as upper part of vagina and adjacent tissues.
  
• Radical hysterectomy with adnexectomy - also ovaries and fallopian tubes from both sides are removed (often performed when cancer is present).

The operation takes place under general anesthesia, its type and extent depends on the reason why the hysterectomy is performed.

In the case of abdominal hysterectomy, the scar is located in the lower abdomen, its healing takes 2 - 3 weeks. It also takes a similar long time to heal for surgical wounds after hysterectomy using other approaches.

Immediately after surgery, bed rest is required and a urinary catheter is inserted to keep the wound clean. Hospitalization is usually around 4 days.

Spotting and discharge may still occur for 2 months after the procedure and increased hygiene is required, intimate parts must be showered - a bath is not recommended. Sexual abstinence is required for 4 - 6 weeks.

For women who still had a regular menstrual cycle at the time of surgery and underwent a radical hysterectomy, hormonal preparations are available to replace ovarian function. No hormonal treatment is necessary for menopausal patients.