Hysterectomy

Hysterectomy is a surgical procedure involving the removal of the uterus. It is one of the most common operations in gynecology and is performed for medical indications such as uterine fibroids, endometriosis, uterine cancer, or chronic pelvic pain. After hysterectomy, a woman loses the ability to carry a pregnancy, as the uterus is the organ in which fetal development occurs.

Types of hysterectomy

Hysterectomy can be performed using several approaches depending on the extent of surgery and the underlying condition:

1. Total hysterectomy. Complete removal of the uterus, including both the uterine body and the cervix. This is the most common type of hysterectomy and is frequently performed for malignant and benign conditions.
2. Subtotal (supracervical) hysterectomy. Removal of the uterine body while preserving the cervix. This approach is used less often, as subsequent cervical pathology may still require treatment.
3. Radical hysterectomy. Removal of the uterus, cervix, upper portion of the vagina, and surrounding tissues, including regional lymph nodes. This procedure is typically performed for gynecologic cancers, such as cervical or endometrial cancer.
4. Hysterectomy with removal of adnexa. In addition to the uterus, the ovaries and fallopian tubes are removed (bilateral salpingo-oophorectomy). This approach may be indicated in cases of fibroids, endometriosis, or malignancy.

Indications for hysterectomy

1. Uterine fibroids. Benign tumors of the uterus that may cause pain, heavy bleeding, or infertility. In some cases, large or multiple fibroids necessitate removal of the uterus.
2. Endometriosis. A condition in which endometrial tissue grows outside the uterus, leading to chronic pain and inflammation. Severe cases may require hysterectomy.
3. Cancer of the uterus, cervix, or ovaries. In malignant conditions, hysterectomy may be required to remove cancerous tissue.
4. Chronic pelvic pain. Persistent pain that does not respond to conservative treatment may be an indication for hysterectomy when uterine pathology is identified.
5. Adenomyosis. A condition in which endometrial tissue infiltrates the uterine muscle, often causing heavy and painful menstruation.
6. Uterine prolapse. Descent of the uterus into or beyond the vaginal canal due to weakened pelvic support structures, which may require hysterectomy for correction.

Surgical approaches to hysterectomy in Belarus

1. Abdominal hysterectomy. Performed through an incision in the lower abdomen. This approach is commonly used for large fibroids, malignancies, or when extensive access to pelvic organs is required. Advantages include broad surgical access; disadvantages include longer recovery time and visible scarring.
2. Vaginal hysterectomy. Removal of the uterus through the vaginal canal. This minimally invasive method is often used for uterine prolapse. Advantages include the absence of visible scars and faster recovery; disadvantages include limited access for large tumors or cancer.
3. Laparoscopic hysterectomy. Performed through small abdominal incisions using a laparoscope and specialized instruments. Advantages include minimal tissue trauma, reduced postoperative pain, shorter hospital stay, and faster recovery. This method requires advanced equipment and surgical expertise.

Preparation for hysterectomy

• Blood and urine tests;
• Electrocardiogram (ECG) to assess cardiac function;
• Pelvic ultrasound examination;
• MRI or CT imaging of the pelvis, if indicated.

A preoperative consultation with an anesthesiologist is usually recommended to determine the most appropriate type of anesthesia.

Hysterectomy is a major surgical procedure that can significantly improve a woman’s quality of life when medically indicated, such as in cases of fibroids, endometriosis, or uterine cancer. Modern surgical techniques, including laparoscopic and robot-assisted surgery, help minimize operative risks and promote faster postoperative recovery.