Hysterectomy Flashcards
List the indications for Hysterectomy
Uterine fibroids: Hysterectomy may be recommended if uterine fibroids cause significant symptoms such as heavy menstrual bleeding, pelvic pain or pressure, urinary or bowel problems, or if they are causing fertility issues.
Endometriosis: In cases where endometriosis causes severe pain, chronic inflammation, and doesn’t respond to other treatments, hysterectomy may be considered.
Adenomyosis: Hysterectomy may be indicated for adenomyosis, a condition where the tissue lining the uterus grows into the muscular wall, causing heavy or prolonged menstrual bleeding, severe pain, and enlargement of the uterus.
Uterine prolapse: If the uterus descends or protrudes into the vagina due to weak supporting tissues, causing discomfort, urinary incontinence, or difficulties with bowel movements, hysterectomy may be recommended.
Pelvic inflammatory disease (PID): In some cases of severe or recurrent PID that doesn’t respond to conservative treatment, hysterectomy may be considered to remove infected tissues and prevent future complications.
Gynecologic cancers: Hysterectomy is commonly performed as part of the treatment for uterine, cervical, or ovarian cancers, depending on the stage and extent of the disease.
Abnormal uterine bleeding: If abnormal uterine bleeding cannot be effectively managed with other treatments, such as hormonal therapies or endometrial ablation, hysterectomy may be considered.
Chronic pelvic pain: In cases where chronic pelvic pain persists despite other treatments and the cause cannot be identified or managed, hysterectomy may be an option.
When is the hysterectomy being done transvaginal?
Non-cancerous conditions: Uterine fibroids, adenomyosis, or uterine prolapse.
No need for extensive removal: If there is no need to remove additional structures such as the ovaries, fallopian tubes, or surrounding lymph nodes, a transvaginal approach may be suitable. This is known as a simple or total transvaginal hysterectomy.
Accessibility and favorable anatomy: The surgeon assesses the anatomy of the patient’s pelvis and determines if the uterus can be safely reached and removed through the vagina. Factors such as pelvic support, vaginal length, and the absence of significant scar tissue or adhesions influence the feasibility of a transvaginal approach.
Patient preference: Some patients may prefer a transvaginal hysterectomy due to its potentially shorter recovery time, fewer visible scars, and reduced risk of certain complications associated with abdominal incisions.
When to perform radical hysterectomy?
Early-stage cervical cancer: Radical hysterectomy is a standard treatment for early-stage cervical cancer (usually stages IA2 to IIA) when the cancer is confined to the cervix and has not spread beyond. It is typically performed in cases where fertility preservation is not a priority.
Invasive cervical cancer: Radical hysterectomy may be recommended for invasive cervical cancer that has invaded the surrounding tissues but has not spread to distant sites. It aims to remove the cancerous tissues and surrounding structures at risk of involvement, such as the upper vagina, parametrium, and nearby lymph nodes.
Select cases of advanced-stage cervical cancer: In some instances of locally advanced cervical cancer (stage IIB to IVA), where the cancer has spread beyond the cervix but is still limited to the pelvis, radical hysterectomy may be considered as part of a multimodal treatment approach. This could involve combining surgery with radiation therapy and/or chemotherapy.
What is removed in case of radical hysterectomy?
Excision of the uterus
Parametrium (ie, round, broad, cardinal, and uterosacral ligaments)
Upper one-third to one-half of the vagina
Bilateral pelvic lymph node dissection.
