Surgical removal of the uterus

Synonyms in a broader sense

Hysterectomy, uterine extirpation, myoma removal, total extirpation of the uterus, subtotal hysterectomy, supracervical hysterectomy

General

An operation in the area of ​​the uterus can take on different dimensions depending on the existing indication.
In the case of a growth that occurs in the muscle layer of the uterus (myoma), uterine-conserving surgery can usually be performed.
Other underlying diseases, however, often make a complete removal of the uterus necessary.
In addition, in the case of malignant growths, it can often be necessary to surgically remove both the uterus and the adjacent ovaries (hysterectomy with unilateral or bilateral adnexectomy). Even with the surgical removal of the uterus, different variants have to be distinguished. In this context, the term “total extirpation” means the complete removal of all parts of the uterus. With subtotal uterine extirpation (synonym: supracervical uterine extirpation), on the other hand, the cervix remains intact even after the operation.
Surgical removal of the uterus (uterine surgery) is one of the most common gynecological operations. In Germany, around 150,000 uterine operations are performed every year.

Indications

The removal of the uterus by surgery can be necessary for many different reasons.

In about 90 percent of cases, such uterine surgery is performed because the affected patients benign diseases (e.g. benign tumors) have been diagnosed. Especially women who are under persistent, untreatable, serious Menstrual irregularities suffer more and more often decide to have a uterine operation.
Other diseases that may be an indication for the removal of the uterus are Endometriosis and pronounced weaknesses of the uterine muscles and ligaments (Prolapse of the uterus).
Only roughly 9 percent In these cases, a complete removal of the uterus by surgery is necessary due to malignant diseases. Put in this context Carcinomas the cervix and tumors of the uterine body or ovaries are the most common surgical indications.
In addition, the presence of inflammatory processes or serious injuries to the tissue may make it necessary to remove the uterus.

Patients who suffer from benign growths of the uterine muscles (myoma) usually do not have to completely remove the uterus. In most cases, it is sufficient to remove the growth in a so-called "uterus-preserving operation" and to check the treatment result at regular intervals. Most patients use the natural access to remove such a fibroid vagina elected to the uterus. Then the benign growth can simply be treated with a Electric loop be removed.

Methods

A basic distinction is made between the common surgical methods between the uterus-preserving and the non-uterine-preserving operation.
Furthermore, the procedures that do not preserve the uterus are divided into simple uterine removal and advanced operations in which adjacent structures must also be removed.
The most important surgical methods in this group include the Hysterectomy with adnexectomy (additional removal of an or in the Ovaries), hysterectomy with pelvic floor surgery and radical surgery for cancer. The choice of the most suitable uterine surgery method depends on the particular indication, the additional interventions required, the size, shape and mobility of the uterus. In general, however, the attending physician tries to proceed as gently as possible and to have to remove as few structures as possible.

Uterine surgery for benign diseases

If the presence of malignant changes in the area of ​​the uterus can be ruled out with certainty, various comparatively gentle surgical methods are available for the complete or partial removal of the uterus. In most cases the surgeon tries to choose a surgical method in which the natural access to the uterus through the vagina can be used (vaginal uterus surgery).
When performing a vaginal uterus, the cervix also removed in most cases.
In the case of pronounced benign findings, it may happen that this access route cannot be used. In such cases it is possible to carry out a laparoscopic Uterus OP. This surgical method usually involves making three small incisions through which a camera and instruments can be inserted into the body. The laparoscopic uterine surgery is one of the so-called minimally invasive operations.
In addition, procedures can be carried out in which a combination is chosen from vaginal and laparoscopic access (LAVH: laparoscopically assisted vaginal hysterectomy). With very extensive findings, however, these surgical methods are often not sufficient.
In cases in which extensive insight into the abdominal cavity must be gained, the uterus should be operated with the help of a Abdominal incision be performed. In contrast to vaginal uterine surgery, the cervix can be preserved in many cases both when performing a laparoscopic hysterectomy and when the uterus is removed using an abdominal incision. Simultaneous removal of the fallopian tubes and ovaries is possible at any time during the laparoscopic uterine operation. Access via the abdominal wall also ensures additional removal of Fallopian tubes and Ovary.

Uterine surgery for malignant diseases

In the presence of malignant diseases, a much more radical uterine surgery method must usually be selected.
Most of the time, the so-called radical hysterectomy according to Wertheim-Meigs.
This uterine surgery method is a complete removal of the uterus with the Holding apparatus and des upper third of the vagina. In addition, the pelvic lymph nodes are operated on in this form of the uterus completely cleared.
The radical hysterectomy according to Wertheim-Meigs is mainly used in patients cervical cancer sick are carried out.

Other uterine surgery methods in the presence of malignant diseases are:

• total mesometrial resection (TMMR)
• laparoscopically assisted vaginal radical hysterectomy (LAVRH)
• laparoscopic radical hysterectomy (LRH)

In the case of young women who wish to have children, a uterus-preserving operation may be considered. However, this is only in early stages of cervical cancer possible.
The standard procedure in such cases is the so-called "Trachelectomy".
In this uterine surgery method, only large parts of the cervix are removed. However, the remaining sections of the cervix and the body of the uterus remain as such. The complementary clearance of the Pelvic lymph nodes can be done in the affected patients via a laparoscopy.
With this type of uterine surgery, fertility is basically preserved.

Basically, you should take it easy after the operation. Depending on the surgical method, exercise should be avoided for a longer or shorter period. Precise information on how to proceed with your surgical method is preferably discussed with the attending physician. You shouldn't do any sport for the first four weeks - walks are fine to stabilize the circulation. Sport can only be started again after 2-3 months.

Complications

In the course of a uterine operation, as with all operations, various complications can occur.
In case of hysterectomy is especially with Wound healing disorders and the creation inflammatory processes to be expected. Due to the narrow anatomical relationships of the pelvic organs, the uterus can be injured during the uterine operation Intestines, of the ureter and / or the bladder come. In addition, as with all surgical interventions, there is a risk of the occurrence of Secondary bleeding which may require a second operation.
In many of the affected patients, a Urinary tract infection can be observed following the uterine surgery.
Other risks of uterine surgery are the emergence of Pain, weakness, fatigue and Exhaustion. These symptoms can persist for weeks and months even after a successful operation.
Also include Hernias, Adhesions and Subsidence of Vaginal remnants to the typical risks of a uterine operation.

consequences

Before making the decision to perform a complete uterus removal, it should be noted that a hysterectomy will irreversibly terminate the childbearing ability of the affected woman.
If the uterus is completely removed, the Uterine lining lost and the Menstrual bleeding no longer occurs.
Only in the subtotal uterine surgery variants in those of the cervix If left on, you may experience slight cyclical bleeding. Even if Fallopian tubes and Ovaries do not have to be removed in addition to the uterus, it can be expected that the affected patient will enter the menopause much earlier. The reason for this seems to be the decreased blood flow to the ovaries after the uterus has been removed.
In addition, it can be far-reaching after such a uterine operation sexual changes come. Some of the affected patients stated that they experienced reduced orgasm sensation after the operation. In addition, in some cases there may be a noticeable shortening and dryness of the vagina.
Sexual desire can also be significantly reduced after performing a uterine operation (Loss of libido).