What is a hysterectomy? A hysterectomy is an operation to remove a woman's uterus (womb). The uterus is where a baby grows when a woman is pregnant. Sometimes the fallopian tubes, ovaries, and cervix are removed at the same time the uterus is removed. These organs are located in a woman's lower abdomen (see image on the right). The cervix is the lower end of the uterus. The ovaries are organs that produce eggs and hormones. The fallopian tubes carry eggs from the ovaries to the uterus. There are several types of hysterectomy: A complete or total hysterectomy removes the cervix as well as the uterus. This is the most common type of hysterectomy. A partial or subtotal hysterectomy (also called a supracervical hysterectomy) removes the upper part of the uterus and leaves the cervix in place. A radical hysterectomy removes the uterus, the cervix, the upper part of the vagina, and supporting tissues. This is done in some cases of cancer.

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How common are hysterectomies?
Hysterectomy is the second most common major surgery among women in the United States. (The most common major surgery that women have is cesarean section delivery.) Each year, more than 600,000 hysterectomies are done. About one third of women in the United States have had a hysterectomy by age 60.

How is a hysterectomy performed?
Hysterectomies are done through a cut in the abdomen (abdominal hysterectomy) or the vagina (vaginal hysterectomy). Sometimes an instrument called a laparoscope is used to help see inside the abdomen. The type of surgery that is done depends on the reason for the surgery. Abdominal hysterectomies are more common than vaginal hysterectomies and usually require a longer recovery time.

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Why do women have hysterectomies? Do alternatives exist?
Hysterectomies are most often done for the following reasons:

• Uterine fibroids. Fibroids are common, benign (noncancerous) tumors that grow in the muscle of the uterus. More hysterectomies are done because of fibroids than any other problem of the uterus. Fibroids often cause no symptoms and need no treatment, and they usually shrink after menopause. But sometimes fibroids cause heavy bleeding or pain.

  There are alternatives to hysterectomy to treat fibroids, which may be especially important for younger women who hope to have children. Sometimes fibroids are treated with medicine or other treatments designed to shrink the fibroids. But, this is only temporary - when the medicine is stopped, the fibroids will grow again. A type of surgery to remove only the fibroids without removing the uterus is called a myomectomy. A relatively new procedure to shrink fibroids is called uterine artery embolization. It involves placing small plastic particles in the blood vessels feeding the fibroids.

• Endometriosis. This is another benign condition that affects the uterus. Endometriosis is the second leading reason for hysterectomies. It is most common in women in their thirties and forties, especially in women who have never been pregnant. It occurs when endometrial tissue (the inside lining of the uterus) begins to grow on the outside of the uterus and on nearby organs. This condition may cause painful menstrual periods, abnormal vaginal bleeding, and sometimes loss of fertility (ability to get pregnant). Endometriosis is usually not a problem for women after menopause.

  Women with endometriosis are often treated with hormones and medicines that lower their levels of estrogen. Surgery to remove the patches of endometrial tissue causing the symptoms may be done using a laparascope or through a larger cut in the abdomen (laparatomy). A hysterectomy is generally not done unless other treatment has failed.

• Uterine prolapse. This is a benign condition in which the uterus moves from its usual place down into the vagina. Uterine prolapse is due to weak and stretched pelvic ligaments and tissues. Other organs such as the bladder can also be affected. Childbirth, obesity, and loss of estrogen after menopause may contribute to this problem. Uterine prolapse accounts for about 16 percent of hysterectomies.

  Treatment may include estrogen therapy, exercises to strengthen pelvic floor muscles, or use of a pessary, a plastic ring inserted into the vagina to help support the uterus. In more severe cases, surgery can restore the sagging organs to their normal location and repair the supporting tissues. Sometimes a hysterectomy may be done if the prolapse is causing severe problems.

• Cancers affecting the pelvic organs account for only about ten percent of all hysterectomies. Endometrial cancer (cancer of the lining of the uterus), uterine sarcoma, cervical cancer (cancer of the cervix), and cancer of the ovaries or fallopian tubes often require hysterectomy. Depending on the type and extent of the cancer, other kinds of treatment such as radiation or hormonal therapy may be used as well.
  
  
• Other reasons why hysterectomies are done include chronic pelvic pain, heavy bleeding during or between periods, and chronic pelvic inflammatory disease.

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What is Laparoscopic Supracervical Hysterectomy?
An alternative to the Abdominal Hysterectomy is a new and innovative procedure and is performed in patients which would normally require an abdominal hysterectomy. With the help of slender laparoscopic cameras and instruments this state of the art procedure is possible. With this procedure the cervix will be preserved; therefore, it is important to make sure that the cervix is not or has not been diseased. With the preservation of the cervix and the connective tissue around it, the integrity of the pelvic support structures will be preserved and there will be less likelihood of prolapse or relaxation of the structures.

Supracervical hysterectomy surgery is performed under general anesthesia. An instrument is initially placed in the uterus through the vagina which will allow us to move the uterus around for better visualization. With the help of the specialized instruments, the abdominal cavity is filled with CO2 gas, which is safe for the patients.

Thereafter, the supracervical hysterectomy cameras and instruments are introduced into the abdominal cavity. With the help of sharp and blunt dissection and specific coagulation instruments, the tissues will be released from their blood supply. Once the major uterine blood supplies have been cut off, the uterus will be separated from the cervical stump. The cervical opening will be coagulated, to avoid future bleeding.

Additional sutures are placed on and around the cervical stump to improve the support structures of the pelvis and avoid future prolapse. Thereafter, the uterus with or without the tubes and ovaries will be extracted through the small incisions via an instrument which allows the doctors to morcellate or cut up the tissues in small pieces. All the tissues will be evaluated by pathology doctors to rule out abnormalities.

Most patients will leave the hospital the next day and are able to return to work and normal activity within 1-2 weeks.

Available at Florida Hospital Celebration Health, Laparoscopic Supracervical Hysterectomy offers patients many high-tech advantages including the empowerment of rapid recovery.

For more information, or to schedule an appointment, please call Florida Hospital Celebration Health's Women's Center for Pelvic Health at 407-303-4190.