When she talks to patients who need a hysterectomy, or the surgical removal of the uterus, Yale Medicine's Linda Fan, MD, makes one thing clear.
"This is not your mother or grandmother's hysterectomy," Dr. Fan, director of Yale Medicine Gynecologic Specialties, tells her patients. "And women often can't believe it when I tell them they can often go home the next day after surgery. It's completely unlike what it used to be."
Traditionally, this surgery was highly invasive due to the need for a large abdominal incision. Today, new research developments and technologies allow surgeons to perform hysterectomies using minimally invasive techniques, which offer smaller incisions, less pain and quicker recovery. At Yale Medicine, our surgeons are skilled at these procedures.
What is a hysterectomy?
Hysterectomy is the surgical removal of the uterus. It is the second most common surgery for women in the United States (after cesarean section), with approximately 500,000 hysterectomies performed yearly.
A hysterectomy may be recommended by a physician for several reasons including: fibroids, endometriosis, adenomyosis, uterine prolapse, abnormal or persistent bleeding, chronic pelvic pain, or some cancers.
Who typically needs a hysterectomy?
Surgery might be necessary for certain conditions that are not adequately treated with non-surgical options (such as medications, small procedures or weight loss). One of the most common reasons for hysterectomy is the definitive treatment of uterine fibroid tumors, which are noncancerous growths of the uterus that may cause heavy bleeding, pain, or other bothersome symptoms.
Hysterectomy may also be recommended for other conditions such as cancer, uterine prolapse (when the uterus falls into the vagina), endometriosis (when cells inside the uterine lining grow outside the uterus and cause pain) and other causes of chronic pelvic pain or bleeding.
After a hysterectomy, a woman will no longer be able to have children. Depending on the severity of the condition, it might be possible to delay surgery until after a woman has completed her family unit.
How is a hysterectomy performed at Yale Medicine?
Yale Medicine physicians emphasize safe, minimally invasive surgical techniques. Some of these include:
- Vaginal hysterectomy: In this procedure the uterus is removed through the vagina. Studies show that vaginal hysterectomy is safer than traditional surgery and requires less hospital recovery time. The physicians at Yale Medicine Urogynecology & Reconstructive Pelvic Surgery are experts in this method, with a track record of success even in complicated cases in which the uterus is larger than normal. However, the vaginal approach is appropriate for every patient.
- Laparoscopic hysterectomy: In this procedure, several small abdominal incisions are used for laparoscopic detachment of the uterus which is then removed through the vagina. This approach also offers quicker recovery, less pain, and shorter hospitalizations compared to traditional abdominal surgery. The physicians in Yale Medicine Gynecologic Specialties are well equipped to perform these advanced surgeries.
What types of hysterectomies can be performed?
There are three primary classifications of hysterectomy:
- Total hysterectomy: The removal of the entire uterus, including the cervix.
- Supracervical hysterectomy: The removal of the body of the uterus, while the cervix is left intact.
- Radical hysterectomy: The removal of the entire uterus and some of the nearby, surrounding tissues. This surgery is primarily for cancerous conditions, including cervical cancer.
What other organs may be removed during a hysterectomy?
At the time of hysterectomy, there may be an indication for the removal of the ovaries and/or fallopian tubes. The indication for this varies and should be discussed directly with a minimally invasive gynecologist.
- Oophorectomy: The removal of one or both ovaries. Removal of the ovaries does lead to menopause, so this should be carefully discussed with the surgeon.
- Salpingectomy: The removal of one or both fallopian tubes.
"We are very thoughtful about deciding whether to remove the ovaries or not," Dr. Fan says. "If we can leave them in safely, then a woman doesn't go into menopause."
What are the complications of a hysterectomy?
While hysterectomy is a relatively safe procedure, all surgeries carry certain risks. The most common risks are: blood loss, postoperative pain, risk of infection, and possible injury to nearby structures (such as the intestines, bladder, blood vessels, nerves, and ureters).
There are also risks of blood clots and complications due to the anesthesia medications. After surgery, it is not unusual to experience pain, constipation and occasional (temporary) problems emptying the bladder. In addition, it is common to have spotting or discharge after surgery.
Many women also have emotional responses to surgery because they can no longer bear children. It is also common for women to feel relief. If you feel depressed or uneasy in the weeks after your hysterectomy, speak to your doctor about counseling services.
"Women also often worry about a hysterectomy affecting their sexual function, but studies have shown that not to be the case," Dr. Fan says.
What makes Yale Medicine's approach to hysterectomy unique?
Women undergoing surgery to remove the uterus or other reproductive organs often fear a long, painful recovery. At Yale Medicine, surgeons are trained in the latest advanced minimally invasive surgical procedures.
"Our surgeons are high-volume, which means they see more patients, have fewer complications and evidence shows they have better outcomes," Dr. Fan says.
Additionally, many hysterectomy patients are able to go home the day after surgery with minimal scarring and lack of oral pain medication needs.
"We work closely with our operating-room colleagues in anesthesia and nursing. We are vigilant about pain control and offer other techniques to manage it without relying only on opioids," Dr. Fan says.