Hysterectomy Flashcards
What are the types of approach to a hysterectomy?
o Vaginal (removed through vagina)
o Laparoscopic-assisted vaginal
o Laparoscopic hysterectomy
What structures are removed in a total, radical, and subtotal hysterectomy?
o Total → uterus and cervix
§ Cervix removed (no smears needed)
o Radical → removal of structures ± BSO
§ I.E. Wertheim’s hysterectomy
§ Cervix removed (no smears needed)
o Subtotal → upper part of uterus removed
§ Cervix not removed (smears needed)
Are smears still done after hysterectomy?
if total or radical AND done due to cancer / CIN, smears are still done at 6 and 18m
What are the indications of a vaginal hysterectomy?
o Vaginal hysterectomy (quicker recovery):
§ Menstrual disorders with uterus <12w size
§ Microinvasive cervical carcinoma
§ Uterovaginal prolaps
What are the indications of a abdominal hysterectomy?
§ Pfannenstiel incision (midline incision if larger masses or malignancy)
§ Uterine, ovarian, cervical, fallopian tube carcinoma
§ Pelvic pain from chronic endometriosis or chronic PID where pelvis is frozen and vaginal impossible
§ Symptomatic fibroid uterus 12w+ in size
What are the contraindications of a vaginal hysterectomy?
Contraindications = malignancy, uterus 12w+ pregnancy
What are the complications of a hysterectomy?
o General = infection, bleeding, failure, damage to local structures, GA complications, VTE
o Augmentin (Co-amoxiclav) given intra-operatively
