Hysterectomy literally means the surgical removal of the uterus. This may be through one of two routes:
- through the abdominal wall:
- classical open abdominal hysterectomy
- laparoscopic procedure
- vaginal hysterectomy - the uterus is brought down through the abdominal wall
The extent of the procedure may also vary:
- total hysterectomy; the entire uterus and cervix is removed
- Wertheim's hysterectomy; total hysterectomy plus all local lymph nodes and a cuff of vagina are removed
- subtotal hysterectomy; uterine body is removed, but the cervix is left
- hysterectomy +/- oophorectomy: one or both ovaries are removed if they contain neoplastic tissue, or are the driving source for an oestrogen-dependent tumour
Hysterectomy is generally carried out for disorders affecting menstrual bleeding and uterine cancer. Pregnancy is no longer possible.
Notes (1):
- taking into account the need for individual assessment, the route of hysterectomy should be considered in the following order: first line vaginal; second line abdominal
- under circumstances such as morbid obesity or the need for oophorectomy during vaginal hysterectomy, the laparoscopic approach should be considered, and appropriate expertise sought
- when abdominal hysterectomy is decided upon then both the total method (removal of the uterus and the cervix) and subtotal method (removal of the uterus and preservation of the cervix) should be discussed with the woman
- removal of ovaries at time of hysterectomy:
- removal of healthy ovaries at the time of hysterectomy should not be undertaken
- removal of ovaries should only be undertaken with the express wish and consent of the woman
- if a woman has a significant family history of breast or ovarian cancer then she should be referred for genetic counselling prior to a decision about oophorectomy
- in women under 45 considering hysterectomy for menorrhagia/heavy menstrual bleeding (HMB) with other symptoms that may be related to ovarian dysfunction (for example, premenstrual syndrome), a trial of pharmaceutical ovarian suppression for at least 3 months should be used as a guide to the need for oophorectomy
Reference:
- NICE (January 2007). Heavy menstrual bleeding.