Hysterectomy for Fibroids Risks of Hysterectomy for Fibroids

Hysterectomy: The surgery to take out all or part of a woman’s womb. Your womb is called a uterus. Animation needs to be edited for entire PPT

Women’s Anatomy Fallopian Tubes Ovaries Uterus Cervix Vagina The uterus is the organ in which a baby grows and causes bleeding during your period. The cervix is the bottom portion of the uterus. It dilates (opens) when you have a baby and is the area in which a pap smear is collected. The vagina is the opening that babies are born from and the opening where women have sex. At the top of the vagina is the cervix. Uterus Cervix Vagina

Women’s Anatomy On the outside, above the opening to the vagina is the urethra, where urine leaves the body. On the outside, below the opening to the vagina is the anus, where feces leaves the body. Use picture Dr. Howard picked out for this

Women’s Anatomy Fallopian Tubes Ovaries Uterus Cervix Vagina Attached to the uterus are your ovaries. These make female hormones and release an egg each month before your period. This happens so that you can get pregnant. The fallopian tubes help the egg travel from the ovary to the uterus. This is also the location where the egg can combine with sperm to make a baby. Around the age of 52, the ovaries slowly stop making hormones and you will stop having periods. You will also no longer be able to get pregnant. This process is called menopause. Uterus Cervix Vagina

Fibroids Fibroid Fibroids are growths or masses that are common and can grow in different places in your uterus. These masses may cause your uterus to become larger. Fibroids are NOT cancer. Sometimes fibroids grow large causing heavy bleeding and pain. There are medications that can treat some of the symptoms of fibroids, but there is no medication to make them go away.  When medications stop working, or if the fibroid grows very large, the only definitive treatment for fibroids is surgery.

Hysterectomy Reason for surgery Description Fibroids The MOST COMMON reason for a hysterectomy Abnormal uterine bleeding Heavy, painful, or irregular bleeding Endometriosis & Chronic pelvic pain Uterine lining that grows outside of the uterus, may cause abnormal uterine bleeding and pain Gynecologic Cancer Cancers of the cervix, uterus, ovaries, or uterine lining Pelvic organ prolapse Uterus dropping down into or out of the vagina Need Photo Make into table without photos

Different Types of Hysterectomy Before Hysterectomy Supra-cervical Hysterectomy Total Hysterectomy Hysterectomy with Salpingectomy Hysterectomy with Salpingo-Oophorectomy Removal of Uterus Only Removal of Uterus and Cervix Removal of Uterus, Cervix, and Fallopian Tubes Removal of Uterus, Cervix, and Fallopian Tubes

Ways to have a Hysterectomy Open (Vertical) Open (Bikini) Laparoscopic Robotic Vaginal Can you please make incisions bolder so easier to see?

How is the Uterus Removed? Open (Large Incision) Laparoscopic/Robotic (Small Incisions) Vaginal (No Abdominal Incision) The uterus is removed as a whole The uterus is removed through the vagina The uterus is removed through the vagina

What Happens if the Uterus is too Big? If the uterus is small, it may be removed through the vagina as a whole, like delivering a baby If the uterus is too big to fit through the vagina as a whole, your surgeon will cut it up into smaller pieces for removal through the small incisions or through the vagina If the uterus is too big to fit through the vagina as a whole, your surgeon will cut it up into smaller pieces for removal through the small cuts or through the vagina Insert figure

What Happens if the Uterus is too Big? If the uterus must be cut up into smaller pieces for removal, the surgeon can put it in a bag and then cut it up so that all the pieces stay inside the bag without spilling into the abdomen The bag is then removed with the uterus inside This can be done through the vagina or the abdomen

Laparoscopic/Robotic Benefits of Different Types of Hysterectomy Open (Large Cut) Laparoscopic/Robotic (Small Cut) Vaginal (No Abdominal Cut) Large scar on the abdomen May be easier for your surgeon to perform than laparoscopic/robotic or vaginal surgery Small scars on the abdomen Shorter time in hospital Shorter recovery at home Less pain after surgery Return to work sooner No scar on the abdomen Shorter time in hospital Shorter recovery at home Less pain after surgery Return to work sooner

Risks of Different Types of Hysterectomy Open (Large Cut) Laparoscopic/Robotic (Small Cut) Vaginal (No Abdominal Cut) Excessive bleeding Blood clot Infection Organ damage (such as bladder, bowel, blood vessels) Death Overall you are at higher risk of infection and blood clot with open (large cut) surgery Excessive bleeding Blood clot Infection Organ damage (such as bladder, bowel, blood vessels) Death You may be at higher risk of bladder damage with laparoscopic (small cut) surgery Excessive bleeding Blood clot Infection Organ damage (such as bladder, bowel, blood vessels) Death

Treatment for Potential Complications of Surgery Risk of Surgery Treatment Excess Bleeding Blood Transfusion Clot Blood Thinners Infection Antibiotics Organ Damage (i.e. bladder, bowel, blood vessels) Additional Surgeries Death Reference: Surgical approach to hysterectomy for benign gynaecological disease, Johanna WM Aarts, Theodoor E Nieboer, Neil Johnson, Emma Tavender, Ray Garry, Ben Willem J Mol and Kirsten B, Cochrane Database of Systematic Reviews, Kluivers, Online Publication Date: August 2015

Recovery after Hysterectomy Open (Large Incision) Laparoscopic/Robotic (Small Incisions) Vaginal (No Abdominal Incision) 2-4 day hospital stay Back to work in 6 weeks on average Requires more pain medication after surgery Longer recovery time at home May cause more scar tissue 1 day hospital stay (some may go home the same day) May go back to work in 2 weeks Requires less pain medication after surgery May cause less scar tissue 1 day hospital stay May go back to work in 2 weeks Requires less pain medication after surgery May cause less scar tissue

Life after a Hysterectomy It is NOT possible to become pregnant or give birth to a child after your uterus is removed If your ovaries are not removed, they will function the same as they did before your surgery Your menstrual period will STOP entirely and NEVER return after your surgery, though you will likely have some spotting immediately following your surgery while you heal Your other organs will move slightly and will fill in the space where your uterus used to be Keep this picture~!

Rare Cancer Cancer Not Cancer There is a rare cancer, called Leiomyosarcoma (LMS). This cancer arises from the muscle of the uterus and can look like fibroids. LMS is a cancer that can spread all over the body and ultimately cause death. Fibroids, however, are non-cancerous and do not spread outside the uterus. Cancer Not Cancer

Leiomyosarcoma (LMS) The chances of a woman with fibroids having an undetected cancer (LMS) is approximately 1 in 500 women. This means that out of every 500 women with fibroids, 1 will have an undetected cancer (LMS) inside the uterus.

Cancer spread throughout the body Leiomyosarcoma (LMS) If there is a cancer inside the uterus that looks like a fibroid and the surgeon removes the uterus by cutting it up into small pieces, the cancer could spread throughout the body. Morcellator picture? Cancer Not Cancer Leiomyosarcoma (LMS) Tissue removal Cancer spread throughout the body

NO cancer spread throughout the body Leiomyosarcoma (LMS) We believe we can limit the spread by putting the uterus in a bag first, before cutting it up. Morcellator picture? Cancer Not Cancer Leiomyosarcoma (LMS) Tissue removal in a bag NO cancer spread throughout the body

Summary The benefits of removing the uterus through laparoscopic/robotic/vaginal surgery include less pain, quicker recovery, and smaller incisions compared to open surgery, however, there may be more risk of damage to the bladder. Laparoscopic Robotic Vaginal

Summary Removing the uterus through a large cut may be easier for your surgeon to perform than laparoscopy, however, there may be more risk of bleeding, infection, blood clots, and death. It also leaves a bigger scar. Add pictures to summarize

Summary If the uterus is too big to fit through the vagina as a whole, your surgeon will cut it up into smaller pieces for removal through the small incisions or through the vagina. Add same picture from slide 11

Summary Risk of unknown cancer within a fibroid uterus is approximately 1 out of 500 women.

Summary Spread of an unknown cancer in a large fibroid uterus may be prevented by putting the uterus in a bag and then cutting it up into pieces to remove it.

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