Hysterectomy Eric Cui Bio 199 Spring 2009

Hysterectomy Usually performed by a gynecologist Uterus is removed Other reproductive organs may be removed No longer able to have a baby Periods will stop

Indications Fibroids Endometriosis Uterine prolapse Cancer of the uterus, cervix, or ovaries Vaginal bleeding uncontrollable postpartum obstetrical haemorrhage Transgender man

Risks and Side Effects Earlier onset of menopause Greater risk of cardiovascular disease Increased chance of osteoporosis and bone fractures Uncontrolled urination Reduced libido Vaginal dryness

Epidemiology Hysterectomy is the second most common surgery among women in the United States One in three women in U.S. had one by age 60 Each year, more than 600,000 are done Over 90% are performed for benign conditions Over 70% also involved the surgical removal of ovaries

Types of Hysterectomy Partial Hysterectomy ▫Removes 2/3 of uterus Total Hysterectomy ▫Removes uterus and cervix Radical Hysterecomty ▫Removes uterus, cervix, and vagina

Types of Incisions Vertical Incision Pfannenstiel Incision

Abdominal Hysterectomy the uterus is removed through an incision in the woman’s abdomen. Most invasive method Incision site at abdomen Hospital stay of 5-6 days Recovery time 6 weeks Possible retention of cervix Required for endometriosis and large fibroids

Vaginal Hysterectomy the uterus is removed through the vagina. Less invasive than abdominal hysterectomy Incision site at inner vagina Hospital stay 1-3 days Recovery time 4-6 weeks Cervix cannot be preserved

Laparoscopic Hysterectomy the uterus is removed in sections through small incisions using a laparoscope Hospital stay 1-3 days Recover time is 4-6 weeks Longer duration of procedure Requires greater surgical expertise Urinary track injuries are more likely Fewer abdominal wall infections or febrile episodes Less blood loss

Robotic Hysterectomy 3-dimensional image Greater articulation Eliminate hand tremors Increased accuracy and precision

References “Hysterectomy.” Wikipedia.. Johnson, Neil, et al. “Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials.” BMJ 2005;330:1478 (25 June). 18 June Kho, Rosanne M. MD, et al. “Robotic hysterectomy: technique and initial outcomes.” Am J Obstet Gynecol 2007;197;113.e1-113.e4. “Laparoscopic Supracervical Hysterectomy.” 18 June Torpy, Janet M., Cassio Lynm, and Richard M. Glass. “Hysterectomy.” JAMA. 2004;291(12): June “Types of hysterectomy.” Online image. 18 June “Vertical and Pfannenstiel incisions.” Online image. 18 June 2009.