Surgical removal of the uterus

Synonyms in a broader sense

hysterectomy, uterine extirpation, myoma removal, total uterine extirpation, subtotal hysterectomy, supracervical hysterectomy

General information

Surgery in the uterus region can take on different dimensions depending on the existing indication. In the case of a proliferation that occurs in the muscle layer of the uterus (myoma), uterus-sparing surgery can usually be performed. Other underlying diseases, on the other hand, often make a complete removal of the uterus necessary.

In addition, malignant growths can often make it necessary to surgically remove not only the uterus but also the adjacent ovaries (hysterectomy with one- or two-sided adnexectomy). Even in the surgical removal of the uterus, different variants must be distinguished. The term “total extirpation” in this context means the complete removal of all parts of the uterus.

In the case of subtotal uterine extirpation (synonym: supracervical uterine extirpation), on the other hand, the cervix remains intact even after the operation. The surgical removal of the uterus (uterine surgery) is one of the most common gynecological operations. In Germany, approximately 150,000 surgical removal of the uterus are performed each year.

Indications

The removal of the uterus by means of surgery can be necessary for many different reasons. In about 90 percent of the cases, such uterus surgery is performed because the patients concerned have been diagnosed with benign diseases (e.g. benign tumors). Especially women who suffer from persistent, non-treatable, serious menstrual irregularities are increasingly opting for uterine surgery.

Other diseases that may be an indication for uterus removal are endometriosis and pronounced weakness of the uterus muscles and ligaments (uterine prolapse). Only in about 9 percent of cases a complete removal of the uterus by means of surgery is necessary due to malignant diseases. In this context, carcinomas of 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 tissue injuries may make removal of the uterus by surgery necessary. Patients suffering from benign growths of the uterine musculature (myoma) usually do not require complete removal of the uterus. In most cases, it is sufficient to remove the growth in a so-called “uterus preserving surgery” and to check the results of the treatment at regular intervals.

For the removal of such a myoma, most patients choose natural access to the uterus via the vagina. The benign growth can then be easily removed with an electrical sling. In principle, a distinction is made between uterus preserving and non uterus preserving surgery.

Furthermore, the non uterus preserving procedures are divided into the simple uterus removal and advanced operations where additional adjacent structures have to be removed. The most important surgical methods in this group include hysterectomy with adnexectomy (additional removal of one or both ovaries), hysterectomy with pelvic floor plastic surgery and radical surgery for cancer. The choice of the most suitable uterine surgical method depends on the respective indication, the additional procedures required, the size, shape and mobility of the uterus.

In general, however, the treating physician tries to proceed as gently as possible and to remove as few structures as possible. Uterine surgery for benign diseases If the presence of malignant changes in the uterus can be safely ruled out, 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 uterine surgery, the cervix is also removed in most cases. In the case of pronounced benign findings, it may not be possible to use this access route.In such cases there is a possibility of performing laparoscopic uterine surgery. This surgical method usually involves three small skin 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 performed in which a combination of vaginal and laparoscopic access is chosen (LAVH: laparoscopically assisted vaginal hysterectomy). However, these surgical methods are often not sufficient for very extensive findings.

In cases where a wide view of the abdominal cavity is required, the uterus should be operated on through an abdominal incision. In contrast to vaginal uterus surgery, the cervix can be preserved in many cases both when performing a laparoscopic hysterectomy and when removing the uterus by means of an abdominal incision. Simultaneous removal of the fallopian tubes and ovaries is possible at any time during laparoscopic uterine surgery.

Access via the abdominal wall also ensures additional removal of the fallopian tubes and ovaries. uterus surgery for malignant diseases In the presence of malignant diseases, a much more radical uterus surgery method must usually be chosen. In most cases, the so-called radical hysterectomy according to Wertheim-Meigs can be considered.

This uterine surgical method involves the complete removal of the uterus with the holding apparatus and the upper third of the vagina. In addition, the pelvic lymph nodes are completely removed in this type of uterus surgery. The radical hysterectomy according to Wertheim-Meigs is mainly performed in patients with cervical cancer.

Other uterine surgery methods in the presence of malignant diseases are: For young women with an existing desire to have a child, under certain circumstances a uterus preserving surgery can be considered. However, this is only possible in the early stages of cervical cancer. 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 cervical body remain as such. The additional removal of the pelvic lymph nodes can be done by laparoscopy in the affected patients.

With this form of uterine surgery, fertility is basically maintained.

  • Total Mesometrial Resection (TMMR)
  • Laparoscopically assisted vaginal radical hysterectomy (LAVRH)
  • Laparoscopic radical hysterectomy (LRH)

In principle, it is important to take it easy after the operation. Depending on the surgical method, sport should be avoided for a longer or shorter period of time.

Exact information on how to proceed with your surgical method should preferably be discussed with the doctor in charge. In the first four weeks you should not do any sports – walks are okay to stabilize the circulation. Only after 2-3 months can you start exercising again.