Myomas, endometriosis growths, cancer and miscarriages are the most common reasons for surgery on the uterus. Depending on the disease, different operations are used: Hysterectomy, conisation, trachelectomy and curettage. The procedures are carried out primarily with access through the vagina or laparoscopically with keyhole technology.
Muscle growths known as myomas are the most common reason for surgical procedures on the uterus. Endometriosis in the uterine muscles and cancer of the uterus (uterine carcinoma) or the cervix (cervical carcinoma) are further reasons for surgery. Depending on the disease and stage of the disease, the uterus is either completely removed (hysterectomy) or only parts of the cervix (conisation) or the uterus (trachelectomy). Efforts are made to retain the uterus during the surgery for women who want to have children. This means they can still get pregnant.
Curettage is carried out for women who have suffered a miscarriage.
Uterine surgery, hysterectomy
The removal of the uterus through the vagina (vaginal hysterectomy) is the most common form of hysterectomy nowadays. Sometimes vaginal hysterectomy is combined with a cystoscopy. This method is known as laparascopic assisted vaginal hysterectomy (LAVH). In some cases, if the vaginal procedure is not possible, a laparascopic procedure in which the cervix is not removed is preferred. This procedure is known as laparascopic supracervical hysterectomy (LSH). Abdominal hysterectomy with opening of the abdominal wall is only carried out in exceptional cases. The following explanations related to the most common procedure, vaginal hysterectomy.
What preparations are carried out before the procedure?
Different clarifications and examinations are undertaken before the procedure. An ultrasound examination and a vaginal endoscopy are among the standard clarifications. Sometimes an ultrasound or a CT examination are also carried out. All blood-thinning medication must be discontinued before the procedure takes place. The operation is usually performed under general anaesthetic. Prior to this, all the usual pre-operative assessments required for a general anaesthetic are undertaken.
How is the operation carried out?
A bladder catheter is firstly inserted to fully empty the bladder. The mouth of the uterus, cervix and finally the uterus are exposed and removed through the vagina. If vaginal hysterectomy is combined with laparoscopy, a laparoscope and also instruments are inserted into the abdominal cavity via small incisions in the abdominal wall.
After the uterus has been removed, the connection between the vagina and abdominal cavity is sutured. The procedure takes one to three hours.
What is the success rate of this procedure?
The results depend on the underlying disease. Myomas are remedied with the surgery. In the case of cancer, the stage of the disease determined the prognosis.
What are the possible complications and risks of this procedure?
This is a low-risk operation and generally proceeds without complications. As with all surgery, the operation may lead to infections, post-operative haemorrhaging or blood clots in rare cases. Sometimes, growths can appear in the abdomen.
What happens after the operation?
After the surgery, the patient is monitored during the recovery phase as they wake up from the anaesthesia. If everything proceeds normally, you can usually leave hospital two or three days after the operation. You should avoid lifting heavy objects and major physical exertion for some time after the surgery. The patient should not engage in sexual intercourse for a while as well. Depending on the underlying disease, regular follow-up check-ups are required.
The removal of the uterus is an emotional experience for some women which can have an effect on their self-image, partnership or sex life.
Conisation is a procedure which can be carried out on women who still have localised cancer of the cervix. Only a small cone is excised from the cervix. The procedure can be carried out on an outpatient basis and under general anaesthetic with access via the vagina. Cervical abrasion is carried out in addition to conisation to remove any cancer cells. The procedure generally only takes around thirty minutes. You can usually leave hospital on the same day. If all the cancerous tissue is removed with the conisation procedure, no further treatments are necessary. After conisation, regular follow-up check-ups are carried out. All physical activity and sexual intercourse should be avoided until the wound has fully healed.
Trachelectomy is carried out on young women who want to have children if the tumour is larger but still localised to the cervix. Trachelectomy involves removing up to 2/3rd of the uterus. However, a pregnancy with a caesarean is still possible. A trachelectomy usually takes place vaginally with access via the vagina, combined with laparoscopy. The preparations, implementation, complications and post-operative treatment are similar to that of a vaginal hysterectomy.
Curettage is carried out in the case of miscarriage or to terminate a pregnancy. The procedure takes place on an outpatient basis and usually under general anaesthetic. The hysteroscope is fed in through the vagina to examine the inside of the uterus. The uterine cavity and the cervix are carefully abraded with a sharp spoon known as a curette. The procedure takes fifteen to thirty minutes. You can usually leave hospital on the same day. After the procedure, physical activity should be avoided, along with bathing, swimming and sexual intercourse for around three weeks.
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