Hysterectomy Flashcards
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What is a hysterectomy?
Removal of uterus +/- cervix
What are the types of hysterectomy?
Total (inc cervix)
Subtotal (leave cervix; smears should be continued)
Salpingoopherectomy concomitant
Wertheims (extended to include lymph nodes and cuff of vagina)
What are the indications for hysterectomy?
Menorrhagia and other menstrual disorders
Prolapse (although risk of recurrence - vault prolapse)
Pelvic malignancy
Other (PID, endometriosis, fibroids if myomectomy etc fail)
What are the risks associated with hysterectomy?
Big 4
Injury to bladder, bowel, vessel, ureters
Scarring (low transverse, midline, laparoscopic scars)
Earlier menopause if ovaries retained (due to sharing of blood supply with uterine arteries)
If laparoscopic, risk of conversion to open
Why is salpingectomy often performed in a hysterectomy?
Some evidence to suggest ovarian cancer originates in fallopian tubes
What other methods can be used for menorrhagia before hysterectomy is considered?
Mirena IUS
Ablation of endometrium
What should women be made aware of?
Operation will leave them infertile
Oopherectomy may be performed if unexpected disease found (but consent must be obtained preop)
What does a subtotal hysterectomy involve?
Considered if all smears normal and if pelvic adhesions/disease make cervical removal impossible
Presence of cervix does not impact sexual function
10% women continue to get cyclical bleeding
What does a Wertheim procedure involve?
Removal of lymph nodes/vaginal cuff for malignancy
Higher rate of complications (esp ureteric injury)
What are the benefits of vaginal or laparoscopic hysterectomy?
Less pain
Shorter recovery time
What is the main indication for vaginal hysterectomy?
Uterine prolapse
What is the name for a radical Wertheim hysterectomy performed vaginally?
Schauta’s hysterectomy
