Hysterectomy is one of the most commonly performed elective operations in the world. Common reasons for hysterectomy include heavy periods and fibroids. For both these conditions, hysterectomy virtually guarantees cure, which is why the operation has a very high satisfaction rate compared with other procedures. 75-88% of women would recommend the procedure to a friend.

Hysterectomy means removal of the uterus. If the cervix is not removed then this is termed a sub-total hysterectomy. The ovaries and fallopian tubes may be removed at the time of hysterectomy (salpingo-oophorectomy); this is a separate part of the operation and the terms complete or total hysterectomy do not imply removal of the ovaries. A radical hysterectomy involves removal of extra tissue adjacent to the uterus and is usually performed for early stage cervical cancer. 

Hysterectomy: when?

The uterus is a muscular organ for bearing children. If a woman desires to retain the ability to conceive, then every effort should be made to conserve the uterus. If this is not the case, then hysterectomy should be part of any discussion regarding treatment options where it is applicable. The woman is the centre of any discussion regarding her treatment and circumstances. 

Hysterectomy: route?

There are a bewildering number of terms for the different means of performing hysterectomy. The basic methods are: vaginal (the operation is performed entirely through the vagina), abdominal (the operation involves opening the abdomen through a vertical or transverse ‘bikini-line’ incision) and laparoscopic or keyhole surgery. More recently, the operation can be performed using the Da Vinci robot.

It is generally accepted that vaginal hysterectomy is the preferred method whenever possible. Research studies confirm that vaginal hysterectomy has the lowest complication rate and offers a faster recovery, with laparoscopic hysterectomy having almost equivalent statistics in experienced hands. Abdominal incisions should be reserved for patients requiring complex surgery for cancer, endometriosis, adhesions or large fibroids, but even these conditions are less likely to necessitate abdominal surgery as robotic surgery comes into wider use.

The advent of the Da Vinci robot will allow surgeons to perform more complex hysterectomies by keyhole surgery with the benefit of fewer complications, reduced pain and a more rapid recovery than ever before.


Hysterectomy: pros and cons

Hysterectomy ‘does what it says on the tin’ in that it is guaranteed to cure all cases of heavy periods and uterine fibroids. It provides extremely effective contraception and usually obviates the need for further cervical smears. It prevents future development of cancer of the endometrium or cervix. Where appropriate, it simplifies HRT therapy. The ovaries may be removed at hysterectomy (including vaginal hysterectomy) and this may be beneficial in younger women with a family history of breast and ovarian cancer. For older women it prevents the development of ovarian cancer in later life. The menopause is due to ovarian failure and oophorectomy should not adversely affect menopausal women.

It should be remembered that hysterectomy is a major surgical procedure with a risk of significant complications. Immediate risks include bleeding and injury to the adjacent bowel, bladder and ureters. Early complications include infection, thrombosis and wound dehiscence; pain and a delay in normal bowel and bladder function may occur. Late complications are very rare and include chronic pain, adhesions, long term bladder and bowel problems and incisional hernia (protrusion of the bowel through the wound, beneath the skin). There may be a problem with HRT in younger women, and lack of libido is a rare but significant risk of this. Every woman should be made aware of the possible psychological effects of removing the uterus and ovaries and she should be given the opportunity to discuss any worries prior to surgery.