Hysterectomy is the most common gynaecological surgery. The uterus may have to be removed if drug treatment for abnormal bleeding or for pain originating from the uterus is not successful. Pelvic organ prolapse and various tumours in the uterus may also require a hysterectomy.
Nowadays the most common way to remove the uterus is by keyhole surgery in the abdomen (laparoscopy) or through the vagina. Open surgery, which used to be the most common method, is rarely needed to perform hysterectomy today.
BEFORE THE PROCEDURE
The skin and mucous membrane in the operation area must be healthy.
The patient must not eat or drink for six hours before she is admitted to the hospital. She can eat normally on the previous evening but must avoid alcoholic beverages. It is possible to have a light breakfast on the morning of the surgery six hours before the procedure. It is recommended that the patient takes a shower at home on the admittance day.
The method of procedure depends on anatomical factors, the size of the uterus and possible additional procedures (repair of pelvic organ prolapse, removal of the ovaries, detachment of adhesions, etc.).
The method of procedure is chosen together with the performing surgeon at the preoperative assessment appointment. At the same time, the decision on possible additional procedures is made.
Vaginal hysterectomy (removal of the uterus through the vagina)
The surgery involves no incisions in the abdomen, and the internal stitches need not be removed. The surgical incision is made in the top of the vagina. Pelvic organ prolapse can be repaired at the same time as vaginal hysterectomy is performed. The ovaries can also be removed but the removal of ovarian tumours is usually not possible. The surgery can be performed under spinal or general anaesthesia. The patient is discharged on the day of the procedure or on the following morning, and will need sick leave for 2–3 weeks.
Laparoscopic hysterectomy (removal of the uterus by keyhole surgery)
The uterus is detached by laparoscopy but removed through the vagina. 2–4 incisions of 0.5–1 cm are made in the abdomen, and an incision is also made in the top of the vagina. At the same time, it is possible to perform other surgical procedures via the abdominal cavity (e.g. removal of the ovaries, detachment of adhesions and removal of endometrial tissue).
The surgery is performed under general anaesthesia. The patient is discharged on the day of the procedure or on the following morning, and will need sick leave for 2–3 weeks. Normally the stitches need not be removed.
Abdominal hysterectomy (removal of the uterus by open surgery)
The uterus is removed entirely through an incision of at least 10 cm in length made into the abdominal cavity. At the same time, it is possible to perform other surgical procedures via the abdominal cavity (e.g. removal of the ovaries, detachment of adhesions and removal of endometrial tissue). The surgery is performed under general anaesthesia.
The patient is discharged after 1–2 days, and will need sick leave for 4 weeks. The patient will receive instructions on the removal of the stitches when she is discharged.
AFTER THE PROCEDURE
If the patient is discharged on the day of the procedure, she will need a support person to assist her at home until the following morning. Driving a car and other activities that require a high level of concentration are prohibited for 24 hours after the procedure.
The patient may suffer from nausea and dizziness after the surgery but this should pass within 12 hours. There will be pain in the operated area after the surgery, for which the doctor will have prescribed painkillers. At the beginning, it is worth taking the painkillers regularly as they also reduce swelling in the wound area. Shoulder-tip pain is an unpleasant yet harmless side effect of laparoscopy but this should pass within two days. The patient may have discharge from the vagina for several weeks, and may feel discomfort for even longer in the operated area and around the wound as well as when she urinates and empties her bowels. Showering the vaginal area several times a day will help to keep the operated area clean. It is alsopossible to have a sauna. The patient must avoid heavy work and physical exertion during the sick leave. Gentle exercise will stimulate circulation in the operated area and speed up recovery. The patient must avoid swimming in a public swimming pool or a spa as well as sexual intercourse during the sick leave.
Hysterectomy will not, however, change the patient’s sexual experience. She will not have periods after hysterectomy. If she has received hormone replacement therapy before the surgery, it is usually continued after the procedure. However, as she no longer needs progesterone, the therapy will only contain the female hormone, i.e. oestrogen.
The recovery from the surgery usually goes well. Most of the postoperative problems are minor and do not essentially extend the period of treatment or slow down the recovery. The most common postoperative complications include infections of the operated area and bleeding. There is also an increased risk of urinary tract infection. These complications may require a course of medication. More serious complications requiring hospital treatment or new surgery can occur but are extremely rare.
The stitches used in the surgery are usually dissolvable. If there are stitches that need to be removed, the patient will receive instructions for their removal. There is no need for a follow-up check unless otherwise agreed on. The removed uterus will be sent for examination. The patient will be informed about the results of the examination in the agreed manner.