Procedures and Surgery
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Hysterectomy

Hysterectomy is a surgical operation to remove the uterus and, sometimes together with the cervix. Removal of the entire uterus and the cervix is referred to as a total hysterectomy. Removal of the body of the uterus without removing the cervix is referred to as a subtotal hysterectomy. Hysterectomy should only be considered after alternative treatments have been explored. This is because the woman cannot bear children herself after this procedure. So the surgery is performed for women who has completed a family or the reason for the surgery is a serious one such as cancer. The following conditions are the most common reasons why women are advised to have the operation.

1. Uterine fibroid
2. Heavy vaginal bleeding
3. Cronic pain in lower abdomen
4. Prolapse (also called a "dropped womb")
5. Cancer of ovary and uterus
6. Endometriosis

Types of hysterectomy
 

Total abdominal hysterectomy

This is the most common type of hysterectomy done nowadays. It is a surgical removal of the uterus through an incision made in the abdominal wall. During a total abdominal hysterectomy, the doctor removes the uterus and the cervix. The abdominal scar may be horizontal (Pfenenstiel) at the upper pubic hair line or vertical (midline) between the umbilicus and the pubic hair line. The pfenenstiel is preferred because it is cosmetically better.

 

Vaginal hysterectomy

During this procedure, the uterus is removed through the vagina. A vaginal hysterectomy is appropriate only for conditions such as uterine prolapse, endometrial hyperplasia, and small fibroid or cervical dysplasia. These are conditions in which the uterus is not too large to be removing through vagina, and there is no need to examine the whole inner abdomen during the surgery. Women who have not delivered vaginally may not be suitable for vagina hysterectomy because the vagina canal is narrow. The advantage of this surgery over abdominal hysterectomy are: there is no scar in the abdomen and post operation pain is less.

Laparoscopy assisted vaginal hysterectomy (LAVH)

Laparoscopy-assisted vaginal hysterectomy (LAVH) is similar to the vaginal hysterectomy procedure, but it has combined the use of a laparoscope. A laparoscope is a very thin viewing telescope with a magnifying glass at both ends. It allows the surgeon to inspect the whole abdomen during surgery.

Subtotal hysterectomy

A subtotal hysterectomy is a surgery that remove the uterus, leaving the cervix behind. The cervical stump that is left behind may cause the woman to have little vaginal bleeding. She is at risk of cancer of the cervix and regular pap smear is required. Because of this reason, subtotal hysterectomy is seldom done nowadays.

Radical hysterectomy (Wertheim hysterectomy)

The radical hysterectomy procedure involves more extensive surgery than a total abdominal hysterectomy because it also includes removing tissues surrounding the uterus and removal of the upper vagina. Radical hysterectomy is most commonly performed for early cervical cancer. The surrounding tissue, lymph nodes and fascia are remove as well to prevent recurrence of cancer. There are more complications with radical hysterectomy compared to abdominal hysterectomy. These include injury to the bowels and urinary system. The advantage of radical hysterectomy to radiotherapy is the ovary and hormone production can be retained.

Oophorectomy and salpingo oophorectomy (removal of the ovaries and/or Fallopian tubes)


Oophorectomy is the surgical removal of the ovary(s), while salpingo-oophorectomy is the removal of the ovary and its adjacent Fallopian tube. These two procedures are performed for ovarian cancer, removal of suspicious ovarian tumors, or Fallopian tube cancer (which is very rare). They may also be performed due to complications of infection of the tubes and ovary, or in combination with hysterectomy. Occasionally, women with inherited types of cancer of the ovary or breast, oophorectomy is done at the same time as a preventive surgery so that recurrence of cancer in the breast or ovary do not occur.


 

Myomectomy

Myomectomy is the removal of the fibroid without removing the uterus. It's recommended for those women who still want to have children.

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