STEC 1070 Surgical Procedures 1 Module 5
September 4, 2013
Hysterectomy

Women are faced with many difficult decisions in life, but the decision on whether or not to have a hysterectomy can be the most difficult one she will ever make. It can threaten her character, sexuality, and fertility and could lead to lingering feelings of grief, depression, and loss. However, having a hysterectomy may be required to decrease pain, increase quality of life or preserve the patients life.
A hysterectomy as defined by Webster’s New World Medical Dictionary is a surgical operation that removes a woman’s uterus. [ (Merriam- Webster) ] The uterus is the organ designed to nourish a developing baby. During, a hysterectomy procedure, the doctor may also remove a woman’s cervix, ovaries, and fallopian tubes. The ovaries produce eggs and hormones while the fallopian tubes provide passage for the eggs from the ovaries to the uterus. The cervix is the lower end of the uterus that joins the vagina. Unfortunately, with a hysterectomy part or all of the reproductive organs will be removed, leaving the patient unable to bear children. If the patient has not yet reached menopause by the procedure and she keeps her ovaries during the hysterectomy, she may enter menopause at an earlier age than most women. If the ovaries are removed during the hysterectomy, the patient will enter menopause. You can talk with your doctor about ways to manage menopausal symptoms, such as hot flashes and vaginal dryness. [ (Edward L. Trimble) ]

Hysterectomies are the second most frequent operation (after cesarean section) performed on adult American women; it has been estimated that one-third of them undergo the procedure by age 60 [ (Keshavarz H) ] The most common reason hysterectomy is performed is for uterine fibroids. Uterine fibroids (also known as uterine leiomyomata) are benign growths of the uterus, the cause of which is unknown. Although the vast majority are benign, meaning they do not cause or turn into cancer, uterine fibroids can cause medical problems. Indications for hysterectomy in cases of uterine fibroids are excessive size (usually greater than the size of an eight month pregnancy), pressure or pain, and/or bleeding severe enough to produce anemia. [ (Edward L. Trimble) ] Many women with fibroids have only minor symptoms and do not need treatment. When symptoms cause severe pain fibroids can be treated with medications or can be removed with procedures such as a myomectomy; in this procedure, the fibroids are removed while leaving the uterus intact. However, the tumors may return.
Other reasons a hysterectomy is needed include endometriosis, prolapse of the uterus, abnormal vaginal bleeding, cervical dysplasia, adenomyosis, and cancer of the uterus, cervix, ovary, or endometrium. Approximately 10 percent of hysterectomies are performed to treat cancer—either cervical, ovarian, or endometrial. [ (Johns Hopkins Medicine) ] Ovarian cancer is often accompanied by symptoms attributable to other disease processes. It is the leading cause of death from gynecologic malignancies. [ (Alexander's Surgical Procedures) ] In the case of cancer, a hysterectomy would be performed utilizing the abdominal approach. An abdominal hysterectomy is most commonly used when the ovaries and fallopian tubes are being removed, when the uterus is enlarged, or when disease has spread to the pelvic cavity, as in endometriosis or cancer. The uterus is removed through the abdomen via a surgical incision(midline incision) about six to eight inches long, or a horizontal (transverse Pfannenstiel) incision, along the top of the pubic hairline is used. The type of hysterectomy you receive depends on your medical history and general state of health and on the extent of the cancer growth. Medical centers and surgeons may choose to do the type of surgery that they have more experience in. [ (Healthwise) ] Other approaches include, * Vaginal-This is done through a cut in the vagina. The doctor will take your uterus out through this incision and close it with stitches. * Laparoscopic- A laparoscope is an instrument with a thin, lighted tube and small camera that allows your doctor to examine your pelvic organs. Your doctor will make three to four small cuts in your abdomen and insert the laparoscope and other instruments. He or she will cut your uterus into smaller pieces and remove them through the incisions. * Laparoscopically assisted vaginal hysterectomy (LAVH)- Your doctor will remove your uterus through the vagina. The laparoscope is used to guide the procedure. * Robotic-assisted- doctor uses a distinctive machine (robot) to do the surgery through small cuts in your belly, much like a laparoscopic hysterectomy [ (Edward L. Trimble) ]
Once the doctor has chosen the right technique for his patient, the surgery will be performed. As with the different approaches of hysterectomy the doctor will also determine which procedure to perform. Again, depending on the severity of symptoms the doctor will decide on what type of hysterectomy he will perform. The most common types are Partial, subtotal, or supracervical which removes the upper part of the uterus and leaves the cervix intact. Total, the uterus and the cervix are both removed. Or radical, which removes the entire uterus, the tissue on both sides of the cervix, the upper part of the vagina, and lymph nodes. Like with any surgery complications are always a possibility, complications of hysterectomy include injury to the ureters with possible fistula formation or renal failure, injury to the bladder or bowel with fistula formation, and massive hemorrhage from damage to major vessels. [ (Nancymarie Phillips, Operating Room Technique) ].
Recovery for any surgical procedure takes time and it is no different for a hysterectomy. Most women will stay in the hospital for 1-2 days after surgery. Some will leave the same day if a laparoscopic or robot assisted procedure is performed. Most women can return to normal activities within 3-4 weeks for vaginal or laparoscopic procedures or 3-6 weeks for abdominal procedures. About 6 weeks after either surgery, you should be able to take tub baths and resume sexual intercourse. Research has found that women with a healthy sex life before hysterectomy can maintain it after the surgery. [ (Landa) ]
In conclusion, medical, psychosocial, and sexual ramifications must be considered when contemplating hysterectomy. The procedure may be life saving, but because it signals the end of the patients reproductive potential, a hysterectomy may cause psychological stress and a sense of incompleteness. [ (Nancymarie Phillips, Operating Room Technique) ] Mental and physical support should be established prior to the procedure. With the various different approaches to the surgical procedure, a patient and the doctor can prepare for the best options to help the patient with quality of life, and while a hysterectomy may be life changing the use of today's technologies can help a patient plan for any complications and lead to a speedy recovery.

Works Cited

"Alexander's Surgical Procedures." Sherri M. Alexander, CST, Jane C. Rothrock, PhD, RN, CNOR, FAAN. Alexander's Surgical Procedures. St. Louis, Missouri: Mosby, 2012. 148.
Anthony R. Lanfranco, BAS, Andres E. Castellanos, MD, Jaydev P. Desai, PhD, *† and William C. Meyers, MD. "Robotic Surgery: A Current Perspective." 2004. Http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356187/#r1-3. 8 June 2013.
Edward L. Trimble, M.D., M.P.H. "Office of women's health hysterectomy fact sheet." 15 December 2009. Womenshealth.gov. 4 September 2013.
Healthwise. Cervical Cancer Health Center by WebMD. 29 November 2010. 5 September 2013.
Johns Hopkins Medicine. N.d. 5 September 2013.
Keshavarz H, et al. Hysterectomy surveillance. United States, 1994-1999.
Landa, Dr. Jennifer. Having Sex After Hysterectomy. 10 March 2013. 5 September 2013.
Merriam- Webster. Springfield, Massachusetts: Merriam-Webster, inc, 2006. Medical Dictionary.
Nancymarie Phillips, RN, BSN,BA. "Operating Room Technique." Nancymarie Phillips, RN, BSN,BA. Operating Room Technique. Mosby, an imprint of Elsevier Inc, 2013. 705.