Hysterectomy

Last revised by Yahya Baba on 15 Nov 2020

Hysterectomy (plural: hysterectomies), the surgical resection of the uterus, is the most commonly performed gynecological procedure in the USA 3. It is usually performed electively.

Approximately 600,000 hysterectomies are performed in the United States annually. After Cesarean section, it is the commonest performed gynecological procedure in women of childbearing age in the USA (CDC data 1994-1999) 3.

There are two basic types in the non-cancer patient

  • (total) hysterectomy: removal of the uterus only
  • supracervical (subtotal) hysterectomy: removal of the uterine body, cervix left in situ

These may be performed vaginally, laparoscopically or as an open surgery, such that the main types are

  • abdominal hysterectomy (AH): open surgery via laparotomy
  • vaginal hysterectomy (VH): removed via the vagina
  • laparoscopic supracervical hysterectomy (LASH)
  • laparoscopically assisted vaginal hysterectomy (LAVH)
  • total laparoscopic hysterectomy (TLH)

Often a salpingo-oophorectomy is performed during the same surgery. This involves unilateral/bilateral removal of the ovaries and fallopian tubes.

Robotic assistance may also form part of some procedures now 3.

In cancer patients, a radical/extended hysterectomy may be performed, which most commonly comprises the removal of the uterus, cervix, upper vagina and parametrium. A concurrent salpingo-oophorectomy is also often performed. Although there are actually a broad spectrum of possible radical hysterectomies, the details of which are outside the scope of this article 2.

The most common underlying conditions leading to hysterectomy are 4:

  • hemorrhage
  • iatrogenic injury to
    • bladder (commonest injury, up to 1% cases) 1
    • bowel
    • ureter
    • blood vessels
  • anesthesia-related complications

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