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Hysterectomy

 

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What is a hysterectomy?
In medicine, hysterectomy is the surgical removal of the uterus.
The two parts of the word "hyster" and "ectomie" are derived from the Greek. "Hyster" means uterus or belonging to the uterus, and "ectomy" can be translated as cutting out.

The different surgical techniques

Abdominal hysterectomy
The doctor removes the uterus and / or ovaries through an incision in the abdomen (the abdomen is usually opened through a cross section in the area of ​​the pubic hairline).
The abdominal hysterectomy gives the doctor a good overview of the surgical area. The surgeon can also easily loosen possible adhesions in this way.

Vaginal hysterectomy
The doctor removes the uterus and / or ovaries through the vagina.
The doctor performs vaginal hysterectomy with special instruments that are inserted through the vagina.
The vagina gradually separates and detaches the uterus and ovaries from the surrounding tissue.
This surgery does not leave any visible scars, and the postoperative recovery time is usually shorter than an abdominal incision.

Laparoscopic hysterectomy
The doctor removes the uterus and / or ovaries with a laparoscopy. Usually 3 to 4 small incisions are made in the abdominal wall, near the navel, so that the instruments (laparoscope) can be inserted.
Gas is brought into the abdomen through a needle. This separates the closely spaced abdominal organs. Then the doctor can look into the abdominal cavity and perform the surgical procedure.
The laparoscopic hysterectomy is still one of the newer surgical procedures. It requires some practice on the part of the surgeon.

Laparoscopically assisted vaginal hysterectomy
The doctor operates with a laparoscopy.
The uterus is removed through the vagina.

In case of uterine cancer, a laparoscopic hysterectomy should never be performed, as cancer cells would otherwise be carried away and could spread to the abdominal cavity.

Which procedure is used depends on the following criteria: 

  • According to the physical condition of the patient  
  • According to the expected difficulties, e.g. as a result of adhesions after previous operations or inflammation
  • According to the size and mobility of the uterus
Gentle surgical procedure for hysterectomy

High-frequency thermofusion saves ligatures
Patients leave the clinic after two days

HAMBURG, 11.2003 (eis) - In the future, high-frequency thermofusion could become the standard procedure for hysterectomies.
Forceps with high-frequency current also coagulate larger vessels. Bleeding and sutures are largely avoided and patients are less stressed than before.

Compared to conventional hysterectomies, there is less pain after interventions with high-frequency thermofusion, the patients recover faster and can be discharged earlier. Dr. Wolfgang Zubke from the University Women's Clinic in Tübingen reports.

The core of the process is the BiClamp® coagulation forceps from Erbe, which are supplied by the Erbe Vio® system with an optimal current and voltage for coagulation.
The walls of the vessel in the cut surface are practically heat-bonded by melting the collagen.
A large area of ​​coagulation is created, which is then cut through with scissors.

The hysterectomy is performed in a minimally invasive manner through the vagina, as was reported at the Medica Preview event in Hamburg.
The vaginal vault and Douglas cavity are opened and the uterine ligaments and vessels as well as the adnexal branch are cut off using thermofusion and scissors, and the uterus is extracted.
Then the vaginal vault is sewn up again. The procedure was developed at the Clinique St. Antoine in Nice and at the University Clinic Tübingen in cooperation with Erbe.
According to initial experience, most patients are discharged from the clinic two days after the operation.

Risks and Complications

Information: Dr. med. Peter Bohi

Despite the conscientious execution of the operation, the success of the treatment and the absence of complications cannot be guaranteed by the doctor. Bleeding may occur during the operation, which is immediately stopped.
Bleeding after the operation can rarely occur, which must then be remedied by a possible second operation. If there is a high blood loss, blood substitutes are given.
Inflammation, wound healing disorders and thrombosis (occlusion of veins by blood clots) cannot always be avoided despite advances in medicine and preventive measures (antibiotics, “blood thinning”).
Since a urinary catheter has to be inserted to empty the urinary bladder for the surgical procedure, bladder irritation or inflammation of the bladder occasionally occurs after the operation, but these can be treated without any problems.
Flatulence and slight abdominal cramps, which must be viewed as temporary functional disorders after abdominal surgery, are not actual complications.
After the operation, permanent sensory disorders of the skin in the area of ​​the skin incision often occur, as fine cutaneous nerves are severed when the skin is opened.
Even with the greatest care on the part of the surgeon, injuries to the surrounding organs such as the urinary bladder, ureter and intestine cannot always be avoided, especially if there are certain risks, such as adhesions.

With laparoscopic hysterectomy, germs can enter the body and cause infections, even under sterile working conditions.
Using the endoscope can injure or perforate mucous membranes and intestinal walls. In the worst case, this can lead to an emergency operation. The scarring following an injury can have other consequences.

Removal of the uterus increases the quality of love life - new study helps to allay fears
Contrary to popular fears, sexual satisfaction does not decrease after the operation, but increases. Dutch researchers found this out in a study in which they asked almost 400 women about the quality of their sexual life before and after a so-called hysterectomy.
The scientists present the results of the study in the British Medical Journal (vol. 327, p. 774).

Many patients fear removal of the uterus could negatively affect sexual well-being.
But even medical professionals are not sure to what extent the hysterectomy changes sexual sensitivity, since the operation destroys various nerve connections and changes the entire anatomical arrangement of the pelvic organs.

The scientists around Jan-Paul Roovers from the University of Utrecht can now at least partially give the all-clear:
Almost all of the subjects they interviewed reported a significant improvement in their sexual life six months after the operation. Many sexual problems have disappeared and enjoyment has also increased, said the patients.
It did not matter whether the uterus had been completely or only partially removed and whether the operation was carried out through the vagina or with the help of an abdominal incision.


PS: Personal note - the hysterectomy also removes the ovaries (oophorectomy). Among those affected this is simply referred to casually as "Ovariohysto".

 

 

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