Hysterectomy - Surgical Operation

There are two main techniques used to perform hysterectomies, Open technique and Minimally invasive techniques.

Open technique is a total abdominal hysterectomy (TAH)
Minimally invasive techniques are

Vaginal Hysterectomy
Laparoscopic Hysterectomy

The ideal surgical procedure for each woman depends on her particular medical condition.

A. Open technique

Abdominal hysterectomy

In November 1843, Charles Clay performed the first hysterectomy in Manchester, England. The body of the uterus was removed while the cervix remained intact. In 1929, Richardson, MD, performed the first TAH (total abdominal hysterectomy), in which the entire uterus was removed (Johns, 1997).

Abdominal hysterectomy can be performed under spinal anesthesia or general anesthesia. The patient remains awake during a spinal anesthesia, with only lower section of the body being numbed to prevent pain. When given a general anesthetic, the person is unconscious.

The steps of the surgery are:

1. The abdominal hysterectomy begins via a surgical incision 6-8 inches long, made either vertically, running from the navel downwards or horizontally, running along the top of the pubic hairline and is popularly referred to as Pfannenstiel incision.

2. On entering the abdomen the attachments of the uterus and its blood supply are dissected and separated.

3. The blood vessels are tied to prevent bleeding and to help in healing.

4. The uterus and cervix are then separated from the surrounding pelvic tissues by applying instruments and cutting at different levels until the upper portion of the vagina is reached.

5. The top of the vaginal tissue is closed with sutures, and the surgical wound is closed in layers.

The advantage of an open abdominal procedure is that the surgeon can see the uterus and other organs and has more room to operate than if the procedure is done vaginally.

On the other hand, the disadvantages of abdominal hysterectomy are: