Hysterectomies can be utilized in many ways for all kinds of reasons. A hysterectomy is an operation that removes a woman’s uterus and cervix.  A supracervical hysterectomy only removes the uterus.  In all cases, menstruation stops and a woman loses the ability to bear children. Sometimes this is an elective procedure, sometimes, this is a lifesaving procedure.

Unfortunately, hysterectomies are common. Studies show that more than 500,000 women have a hysterectomy every year and one-third of women will have a hysterectomy by age 60, according to the CDC.

Female Reproductive Organs

A hysterectomy is the removal of a woman’s uterus and cervix. This does not include the removal of the ovaries. When a woman removes the ovaries and tubes, that is called an oophorectomy.

When a woman has a hysterectomy, she doesn’t have to deal with the occurrence of “the change” or menopause. Since hormone production is sourced at the ovaries, menopausal symptoms like anxiety, depression, hot flashes, osteoporosis, sexual dysfunctions, dryness, and night sweats won’t happen.

• The cervix is the lower, narrow part of the uterus (womb) and forms a canal that opens into the vagina, which leads to the outside of a woman’s body.
• Fallopian tubes are two, thin muscular channels in the female reproductive system that connect the ovaries to the uterus. They create the path that the eggs use to travel from the ovaries to the uterus.
• The ovary is one of a pair of female reproductive glands located in the pelvis, one on each side of the uterus. Ovaries produce eggs and female hormones.
• The uterus, often called the womb, is a muscular organ in the lower part of a woman’s body in which a fertilized egg implants and develops into a fetus.
• The vagina is a muscular passage that connects the cervix with the outside of the body.

Why Would A Hysterectomy Be Considered?

There are many reasons a woman may have a hysterectomy that we could dive into. Some of them being:

• Heavy periods, which can be caused by fibroids, noncancerous growths on the uterus
• Pelvic pain, which may be caused by endometriosis, unsuccessfully treated pelvic inflammatory disease (PID), adenomyosis or fibroids
• Prolapse of the uterus, when pelvic floor muscles and ligaments stretch and weaken and no longer provide enough support for the uterus
• Cancer of the womb, ovaries or cervix
• Tested positive for the BRCA gene – the BRCA gene increases the risk for both breast and ovarian cancer. 

A hysterectomy can reduce or eliminate risk for any of them.

The three primary reasons a hysterectomy would be performed is:

• Removal of fibroids, which are non-cancerous tumors
• Treatment of endometriosis, the growth of the uterine lining outside of the uterus
• Resolve uncontrolled bleeding caused by adenomyosis, cancer or pelvic organ prolapse

In What Way Is The Surgery Performed?

About one third of U.S. hospitals perform hysterectomies through open surgery. However, although about 45% of women undergo invasive open abdominal hysterectomies, there have been developments in new forms of laparoscopic hysterectomies that are less invasive. 

Depending on the reason for the surgery, the entry could be through the abdomen or the vagina to be able to reach the uterus. 

Many women today also choose to have robotic-assisted laparoscopic hysterectomies. These surgeries are where the surgeon uses a computer to control the surgical instruments. A robotic-assisted total laparoscopic hysterectomy is done by making 8-millimeter incisions in the abdomen. The healing and recovery on these surgeries are easier and leave scars that are hardly noticeable. 

Recovery time usually means that the woman is able to leave the hospital the same day as her surgery. Healing time being within a week and back to work or regular schedule within that time frame.

Prior to robotic surgeries, women would have to be in the hospital for at least a week or with a recovery time up to six weeks.

Type of Hysterectomy Techniques

• Open abdominal hysterectomy, or a “traditional” hysterectomy is performed in a hospital and entails removing a woman’s uterus and cervix through an eight inch incision at the bikini line – similar to the incision for a Cesarean Section.  Open procedures usually require staying in the hospital 3-5 days and a recovery time of 6-8 weeks.
• Total vaginal hysterectomy entails removing the uterus and cervix through an incision deep within the vagina. Vaginal hysterectomies involve a shorter time in the hospital and have a faster recovery than an open abdominal hysterectomy. However, if the woman’s uterus is enlarged or there is scar tissue in the pelvis from prior surgery vaginal hysterectomy may not be possible. This procedure is performed without any visual assistance in the abdominal cavity. 
• Total laparoscopic hysterectomy is a minimally invasive procedure, which removes the uterus and cervix, and requires three to four, 5 millimeter incisions in the abdomen. After surgery, patients have a much quicker recovery than with an open abdominal hysterectomy, usually going home the same day or staying overnight in the hospital. 
• Robotic hysterectomy removes the uterus and cervix through laparoscopic incisions in the abdomen. Also performed in a hospital, a robotic hysterectomy typically involves five, 8-12 millimeter incisions in the abdomen. It may also take longer to conduct the surgery, which means the woman may be under anesthesia longer and increase the surgical risks. 
• Laparoscopically assisted vaginal hysterectomy (LAVH) uses a laparoscope to guide the removal of the uterus through the vagina. Through this surgical procedure, three to five ports are located in the pelvis, ranging in size from 5 to 10 millimeters. Although the scars, pain and recovery time from LAVH are usually significantly less than an abdominal surgery, LAVH can be a longer operation and more expensive than a vaginal hysterectomy and other minimally invasive laparoscopic surgical options.
• DualPortGYN hysterectomy, a pioneering new procedure, uses only two, 5 millimeter incisions to remove the uterus and cervix with the use of laparoscopy. One incision is placed at the belly button and the other is at the C-Section line. With these incisions, large fibroids and masses can be removed safely in less than one hour.

There are many types of hysterectomy surgeries and because of this, narrowing recovery times can vary. Depending on the type of procedure, recovery can be from one week to 8 weeks. 

Conventional: 2 hour surgery – 4 incisions – 5MM incision size – 2 week recovery time – 0-1 day stay

Open: 1-2 hour surgery – 1 incision – 10-12 inch incision size – 6-8 week recovery time – 3-5 day stay

Robotic: 2-4 hour surgery – 5 incisions – 8-12MM incision size – 2-4 week recovery time – 1-2 day stay

DualPortgyn: <1 hour surgery – 2 incisions – 5MM incision size – 1 week recovery time – 0 day stay

Robotic surgery sounds like something out of a futuristic movie, but these phenomenal systems have been evolving for over three decades.

Today’s refined robotic systems use cutting-edge technology to safely perform minimally-invasive surgery. The doctors at Rosh Maternal & Fetal Medicine have years of experience using robotic surgery for many gynecologic procedures. If you wonder whether your gynecologic condition could be treated with robotic surgery, call their office in the Midtown East area of New York City, or schedule a consultation online.

Hysterectomies And Their Risks

Although hysterectomies are considered one of the safest surgeries out there, there will always be risks. As with any surgery, heavy bleeding, infection, adverse reactions to anesthesia, potential for the closure of the top of the vagina coming undone, blood clots, and injury to organs are the most common. 

Certain risks and complications are associated with the type of surgery that is performed. 

When undergoing any surgery, remember to ask your doctor questions. This is to ensure you have the knowledge to make decisions based on the surgery and you’re comfortable with the expectations and experience.

Asking some background questions will help you weigh out the answers. Be your best advocate, you may even want to get a second opinion for good practice. There are different surgical options and it’s not a one-size-fits-all surgery. A second opinion can also help determine which hysterectomy surgery is best for you depending on how it will be performed, recovery time and possible risks and complications.

Consider asking some of the following questions:

• If I don’t have a hysterectomy, what will happen?
• What are my other options?
• Given my condition, what are the pros and cons of having a hysterectomy?
• Will I need medications after surgery?
• What changes to my mood will I have?
• How can a hysterectomy relieve my symptoms?
• What kind of hysterectomy should I have?
• Will I automatically go into menopause?
• What are the symptoms of menopause?

Unfortunately with a hysterectomy, a woman cannot get her period or be able to get pregnant. If this is something you are considering, make sure to talk to your healthcare provider about your alternative options. If a hysterectomy is necessary, use your healthcare provider as a resource for options like surrogacy and adoption.

Considering a Hysterectomy or Robotic Surgery? Call Rosh MFM in NYC

Many women only visit their gynecologist for birth control, a routine Pap test, or a vaginal infection, but gynecology embraces more than routine health care.

At Rosh Maternal & Fetal Medicine, the team specializes in women’s wellness and provides expert diagnosis and treatment of all reproductive health issues no matter how routine or complex. They welcome women of all ages, so if you have any questions or it’s time to schedule an annual exam, call their office in the Midtown East area of New York City or book an appointment online.