What is hysterectomy
A hysterectomy is a surgical procedure whereby the uterus is removed. This is the most surgery following caesarean in women. Hysterectomy for noncancerous reasons is usually considered only after all other treatment approaches have been tried without success.
Indications for hysterectomy
A woman may have a hysterectomy for different reasons, the most common one is
Uterine fibroids that cause pain, bleeding, or other problems.
Uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal.
Abnormal uterine bleeding which happens due to hormonal imbalance if not responding to medical treatment.
Adenomyosis of uterus (enlargement of uterus)
Endometriosis with severe pelvic pain
Cancer of uterus, cervix and ovary
How hysterectomy is done?
Depending on the reason for the hysterectomy, the surgeonwill decide the type of hysterectomy
In a subtotal hysterectomy- only the upper part of the uterus is removed, leaving behind the cervix. In this type hysterectomy patient need to undergo routine Papsmear.
In total hysterectomy, uterus and cervix is taken out. The ovaries may also be removed a procedure called oophorectomy or they may be left behind.
In a radical hysterectomy, the whole uterus, tissue on the sides of the uterus, the cervix, and the upper part of thevagina are removed. This kind of hysterectomy is done when there is endometrial or cervical cancer.
There are two approaches for hysterectomy –
Open abdominal Hysterectomy
Minimally invasive procedure (Laparoscopic and Robotic Hysterectomy)
Open Abdominalhysterectomy: In a total abdominal hysterectomy, the doctor removes the uterus, including the cervix. The scar on the abdomen may be horizontal or vertical, depending on the reason the procedure is performed.
Vaginal hysterectomy: The surgeon makes a cut in thevagina and removes the uterus through this incision. The incision is closed, leaving no visible scar.
Laparoscopic hysterectomy: This surgery is done using a laparoscope, which is a tube with a lighted camera, and surgical tools inserted through several small cuts made in the belly or, in the case of a single site laparoscopic procedure, one small cut made in the belly button. The surgeon performs the hysterectomy from outside the body, viewing the operation on a video screen.
Robot-assisted laparoscopic hysterectomy: This is similar to a laparoscopic hysterectomy, but here the surgeon uses a robotic system of surgical tools from outside the body. This technology allows the surgeon to use natural wrist movements and view the hysterectomy on a three-dimensional screen.
What are the alternatives to hysterectomy?
In case of problems with hormones we can try by giving hormone in the form of Tablets, injections, intrauterine device. These may control heavy bleeding or shrink fibroids.
Endometrial ablation is an outpatient procedure to remove the lining of the uterus. This procedure may be effective for controlling heavy bleeding when the patient has completed the family.
Uterine artery embolization is a surgical treatment used to block the blood supply to fibroids, causing them to shrink in size.
Myomectomy is a surgical procedure to remove fibroids while leaving the uterus intact. This is an option for patients who want to have children, but there is some risk that fibroids will grow back after the surgery.
Focused ultrasound surgery is a non-invasive procedure that uses ultrasound waves and a specially adapted MRI scanner.
What is fibroid and how common it is?
Uterine fibroids are common non-cancerous (benign) growths that develop in the muscular wall of the uterus. Fibroids are the most common tumours of the uterus, fibroids are also called leiomyoma, leiomyomata, myoma and fibromyoma.
Size may vary from small, undetectable by the human eye, to huge size that can distort and enlarge the uterus. They can be single or multiple, in extreme cases expanding the uterus so much thatit reaches the rib cage.Prevalence of Uterine Fibroids20- 40 per cent of women aged 35 yrs and older have uterine fibroids. African women are at a higher risk for fibroids
How will I know that I have fibroids?
Most fibroids do not cause symptoms. Only 10 to 20 % of women who have fibroids require treatment. If you are suffering from any of these symptoms consult your gynaecologist, on examination or by ultrasonography we will be able diagnose fibroids.
Heavy, prolonged menstrual periods and unusual monthly bleeding, sometimes with clots; this can lead to anemia Pelvic pain and pressure.
Pain in the back and legs.
Pain during sexual intercourse.
Bladder pressure leading to a frequent urge to urinate.
Pressure on the bowel, leading to constipation and bloating.
Abnormally enlarged abdomen.
What is the cause of fibroid, can I avoid getting fibroids?
No specific risk factors that promote the formation of fibroids have been identified;, but it has been found that its growth depends on estrogen. They have shown increasing in size in reproductive age, during pregnancy and usually regress following menopause. Certain research also shows that genetics and insulin-like growth factor can also cause fibroids. Some, researchers have found that the women most likely to develop fibroids are those who.
have never been pregnant,
have a family history of fibroids,
Unfortunately, because the cause of the tumors is not known exactely, there is no way to prevent the onset of uterine fibroids. If a woman falls into any one of the categories that make her most at risk, she should be checked for fibroids at each visit to her doctor.
Treatment options for fibroid uterus?
Many women with uterine fibroids experience no signs or symptoms, or only mild signs and symptoms. Observation with sonography at routine intervals is the best option.
Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don’t eliminate fibroids, but may shrink them . Medications include includes mainly hormones.
MRI-guided focused ultrasound surgery (FUS) is:
A noninvasive treatment option for uterine fibroids that preserves your uterus, no cuts and is done on an outpatient basis.
Done inside an MRI scanner done with a high-energy ultrasound transducer for treatment. After localisingthe fibroid, the ultrasound transducer focuses sound waves into the fibroid to heat and destroy small areas of fibroid tissue.
Newer technology. Researchers are learning more about the long-term safety and effectiveness.
Uterine artery embolization.
Small particles are injected into the arteries supplying the uterus, cutting off blood flow to fibroids, causing them to shrink and die. This technique can be effective in shrinking fibroids and relieving the symptoms they cause. Complications may occur if the blood supply to your ovaries or other organs is compromised.
Minimally invasive procedures
Laparoscopic myomectomy. Done in young patients and in those who wants to preserve uterus for future pregnancy. In a myomectomy, surgeon removes the fibroids, leaving the uterus in place. With advancing technology, we are now able to remove multiple and huge fibroids laparoscopically.
Hysteroscopic myomectomy. This procedure may be an option if the fibroids are contained inside the uterine cavity
Laparoscopic Hysterectomy. For those who have completed the family and old patients.
Risk of developing new fibroids?
For all procedures, except hysterectomy, small microscopic fibroids doesn’t detect during surgery can eventually grow and cause symptoms that warrant treatment. This is often termed the recurrence rate. Those with single fibroid recurrence risk is low when compared to multiple fibroids. Some research has shown 5-30% recurrence over 5-10 years.
What is ovarian cyst, do all ovarian cysts need surgeries.?
Ovarian cysts are closed, sac-like structures within the ovary that are filled with a liquid or semisolid substance. 95% of the ovarian cysts are non-cancerous. The treatment of an ovarian cyst depends upon diagnosis, simple cysts usually needs observation, persistent cyst and complex cysts needs surgery.
why laparoscopy in infertility is required ?
We call as Infertility if the women not able to conceive in spite of having frequent, unprotected sex for at least a year. Infertility can be from both partners and unexplained.
Laparoscopy in infertility id done to check your fallopian tubes, ovaries and uterus, it can identify endometriosis, scarring, blockages the fallopian tubes, or any problems with the ovaries some of these things which are not picked with ultrasonography. If any problems are found then they can sometimes be corrected with operative laparoscopy.
Laparoscopy can be used for diagnosis, treatment or both. A diagnostic procedure can turn into treatment if some findings are noted.
Some reasons for diagnostic laparoscopy are:
unexplained pelvic pain.
history of pelvic infection
What is hysteroscopy and for what it is done.?
Hysteroscopy in which camera (Hysteroscope) is inserted through birth canal in to the uterus to look in to the lining of the uterus to diagnose and treat abnormal conditions like polyps, fibroids, septum and other causes of abnormal uterine bleeding inside the uterus.Advantage is that there won’t any cuts on the abdomen