Operation of the uterus

Today, surgery on the uterus is one of the most common procedures in gynecology. Disease patterns that require surgery on the uterus include malignant changes (i.e. cancer or suspected cancer), benign changes (e.g. cysts or fibroids), endometriosis, adhesions or inflammations. In principle, in addition to the classic method, which requires opening the abdominal wall, two new options are available for surgery on the uterus: The vaginal (access through the vagina and thus no scarring) and laparoscopic surgery (laparoscopy, i.e. only tiny skin incisions through which surgical instruments and camera/light source are inserted).

Removal of the uterus

The surgical removal of the uterus – also called hysterectomy – can mean either the sole, complete or partial removal of the uterus or an additional removal of the ovaries and fallopian tubes (adnexa) – depending on the indication. The most common reasons for uterus removal include benign diseases of the uterus, such as myomas (Uterus myomatosus), cysts or endometriosis lesions, but also serious, stressful menstrual irregularities or complaints or a prolapse of the uterus (uterine prolapse). Only in just under 10% of cases does the uterus have to be removed because of a malignant disease (e.g. cervical cancer, endometrial cancer, ovarian cancer).

In addition, hysterectomy can also be used as a last resort in cases of insatiable bleeding after childbirth or in cases of severe infection or inflammation of the uterus.Depending on the underlying disease, concomitant diseases, size and mobility of the uterus and the patient’s wishes, different surgical methods can be considered. In general, a distinction is made between conservative surgery through the abdomen (abdominal hysterectomy), through the vagina (vaginal hysterectomy) or laparoscopic surgery with the keyhole principle through the abdominal wall. In addition, a robot-assisted hysterectomy with the DaVinci robot is now also possible.

In the case of benign diseases of the uterus, a vaginal, abdominal or laparoscopic approach is usually chosen, whereby the uterus is either only partially (subtotal extirpation; the cervix is preserved) or completely removed (total extirpation) or even the fallopian tubes are taken (varies depending on the disease; in principle, in the case of benign diseases, the aim is always to preserve as much as possible). Abdominal hysterectomy is preferably performed in the case of a very large uterus (e.g. in the case of myomatosus uterus) or in the case of a partial removal, whereby the uterus is removed in the classic manner under general anesthesia via an abdominal incision. Vaginal removal, on the other hand, is the gentler and faster option, as the surgical route is shorter and the procedure less invasive.

The uterus is removed through the vaginal canal, but it is not possible to preserve the cervix. If there is a malignant disease of the uterus, from a certain stage of cancer, the so-called radical hysterectomy according to Wertheim-Meigs is usually resorted to. This involves the complete removal of the uterus including its supporting apparatus, the lymph nodes of the pelvis and the upper third of the vagina.

Depending on the anatomical conditions and the patient’s state of health, this operation can be performed conservatively abdominal or laparoscopically. The removal of the uterus also irrevocably removes the possibility of conception, which should be clearly explained to the patient before the operation. If the patient still wishes to have children, an alternative, uterus-preserving therapy can be considered with the doctor – depending on the disease of the uterus. Further consequences of a hysterectomy are the complete absence of menstruation (in the case of total removal) or a slight cyclical bleeding in the case of only partial removal of the uterus, hormonal changes and – depending on the age at the time of the operation – a possible onset of menopause if the adnexes are also removed.