What Is A Hysterectomy?
A hysterectomy is a surgical procedure that removes the uterus (where the menstrual blood originates) and can also include the cervix (where the PAP smear is taken). Although a hysterectomy is a common procedure, we often clarify to patients that a hysterectomy does not include the removal of the tubes and ovaries (the organ which produces the female hormones). Specifically, removal of the ovaries is called an oophorectomy. If indicated, removal of the uterus and the ovaries is called a hysterectomy with a bilateral oophorectomy. Removal of the fallopian tubes during hysterectomy does not affect hormone production and also reduces risk of cancer, which can be done during hysterectomy without removing the ovaries.
Types of Hysterectomy: Does not include removal of the ovaries
- Total Hysterectomy – surgically removes the body of the uterus and the cervix.
- Supracervical (Partial) – surgically removes the uterus only and not the cervix.
Shown here are images which better explain the difference between varied procedures.
Original Images Courtesy of BARD Medical – Subject to Copyrights. Labeling Enhanced for Educational Purposes by D. K. Veronikis, MD
The image to far left shows normal anatomy with a complete uterus (uterine body and cervix). The center image depicts a hysterectomy which is removal of only the uterine body and cervix. The image to the far right shows a partial hysterectomy, defined as removal of only the uterine body. These definitions hold true regardless of surgical modality for hysterectomy or partial/supracervical. Removal of the tubes and ovaries, regardless of surgical approach, is called a salpingectomy and oophorectomy. The term hysterectomy has never implied removal of the tubes and ovaries. Tubes and ovaries are not shown in these anatomic illustrations.
The type of procedure a woman needs clearly depends on the reason for her diagnosis. Removal of the tubes and ovaries (the adnexa) is usually for a different reason. The ovaries produce the hormones and not the uterus. Keeping the ovaries or removing the uterus does not mean the woman must take hormone supplements.
Not every patient with prolapse requires a hysterectomy. Uterine preservation is a viable option for women who have not completed child bearing or simply for women who desire uterine preservation. We have been proponents of uterine preservation for over two decades.
Hysterectomy may be recommended by a physician to help restore quality of life to the patient as a result of a diagnosis of other pelvic complications including:
- The uterus falling from its normal position into and often out of the vaginal canal. (Uterine Prolapse and Uterovaginal Prolapse)
- Abnormal uterine bleeding (heavy periods)
- Tumors on and in the uterine wall (uterine fibroids)
- The thickening of the muscle of the uterus with endometrium (adenomyosis)
- Build-up of excess tissue in or around the uterus (endometriosis)
There are typically three ways to perform a hysterectomy:
1) Vaginal Hysterectomy – a cosmetic, non-invasive, no incisions using the natural opening of the vagina.
2) Laparoscopic or Robotic – Minimally invasive using small incisions,one in the belly button and three or four in the abdomen.
3) Abdominal – Maximally invasive which involves a 5-7 inch incision (bikini cut) in the lower abdomen.
We specialize in performing cosmetic vaginal hysterectomy (non-invasive/no incisions). When other approaches are required we can also combine that with abdomino-plasty (tummy tuck).
“If a hysterectomy is required, the non-invasive vaginal approach with no incisions is the best solution for the patient. Just like it sounds, it’s non-invasive to the body without cutting any other tissues to perform the hysterectomy, this translates to a quicker recovery. Additionally, childbirth trauma from vaginal delivery can be repaired at the same time during vaginal hysterectomy.” D. K. Veronikis, MD