1. Hysterectomy for Fibroids
Risks of
Hysterectomy for Fibroids

2. Hysterectomy:
The surgery to take out all or part of a woman’s womb. Your womb is called a uterus.
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3. 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

4. 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

5. 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

6. 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.

7. 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
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8. 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

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

10. 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

11. 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
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12. 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

13. 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

14. 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

15. 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

16. 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

17. 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~!

18. 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

19. 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.

20. 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

21. 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

22. 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

23. 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.
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24. 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.
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25. Summary
Risk of unknown cancer within a fibroid uterus is approximately 1 out of 500 women.

26. 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.

27. Credits