For appointment and information, you can rich us on +90532 433 6003(whatsapp)
Obstetrician, Gynecologist, Genital Esthetic Surgeon in TurkeyFor appointment and information, you can rich us on +90532 433 6003(whatsapp)
Obstetrician, Gynecologist, Genital Esthetic Surgeon in Turkey
Hysterectomy is one of the most commonly performed gynecological operations. Hysterectomy meaning is the removal of the uterus (womb) so that the patient cannot become pregnant again. Therefore it is not the first choice of treatment for patients who desire future fertility.
For most gynecological pathologies, organ preserving surgery is chosen unless uterus removal is absolutely necessary. Uterus should be preseved when possible if future fertility is desired.
Hysterectomy is performed for the following pathologies:
Hysterectomy may be classified into three types according to the extent of tissues removed:
Technically a hysterectomy may be performed by one of the following methods:
Abdominal hysterectomy: An incision is made in the pelvic region horizontally (pfannenstiel incision) it is the same incision used for a Cesarian section and the uterus is removed through this incision. For radical hysterectomy, a longer vertical incision may be necessary.
Vaginal hysterectomy: No abdominal incisions are necessary since the uterus is removed through the vagina. Recovery is easier compared to an abdominal hysterectomy. It may not be technically possible when the uterus is too big to remove through the vagina or when there are adhesions around the uterus.
Laporoscopic hysterectomy: Several 0.5 to 1 cm incisions are made on the abdominal wall and trochars are inserted through these incisions. A camera is inserted through one of the trochars and the uterus is removed through the vagina after safely cutting and binding its attachments on the pelvic walls using instruments inserted through the trochars. It may be preferred because of shorter hospitalisation time and easier recovery compared to abdominal hysterectomy.
Robotic hysterectomy is a the type of hysterectomy performed by using advanced technology.
About half of the woman undergoing a hysterectomy over 40 years of age have their ovaries removed. The reason to remove healthy ovaries during a hysterectomy is to prevent future ovarian cancer.
Although it is common for gynecologists to offer oopherectomy to postmenopausal patients undergoing hysterectomy, a recent study has shown that this approach has no survival advantage, in contrast, in women undergoing oopherectomy less than 65 years of age, the risk of certain health problems increases. Therefore routine ovarian removal should not be offered to patients during hysterectomy performed for benign conditions.
Several complications may occur after a hysterectomy procedure just like every other surgery. Hysterectomy complications may be summarised as:
Every approach has its advantages and disadvantages. Choosing the type of hysterectomy should be a tailored decision for each patient that must be discussed with their surgeon, so there is no single answer to this question.
The only change in a woman’s body after an uncomplicated hysterectomy is that she can not get pregnant again. She will not have menstruations but her life will not change.
There may be several complications after a hysterectomy just like every other surgical procedure and these are mostly seen in high risk patients with medical conditions, obesity and smoking.
These complications can be summarised as:
Average full recovery from a hysterectomy is around 4-6 weeks.
Average full recovery from a laporoscopic hysterectomy is around 3 weeks.
Whether it is abdominal hysterectomy, vaginal hysterectomy or laporoscopic hysterectomy, bed rest is recommended especially during the first two weeks after surgery for easier recovery.
It is recommended to have a bed rest about 2 weeks after a hysterectomy.
Laporoscopic hysterectomy is a major abdominal surgery, although it is less invasive than an abdominal hysterectomy.
Uterus is taken out through the vagina after a laporoscopic hysterectomy.
Abdominal hysterectomy incision is usually horizontal in the pelvic region and it is called a phannenstiel incision. It can be closed using esthetic self-dissolving sutures and it usually heals with a thin hardly visible scar line below the bikini line unless there is a complication.
The most common reasons for hysterectomy are fibroids, pelvic pain and prolapse of the uterus.
During a hysterectomy procedure, the removal of both fallopian tubes and sometimes the ovaries may be added when necessary.
Ovaries are hormon producing organs and when ovaries are removed during hysterectomy, patient starts experiencing menopausal symptoms such as hot flush in the post-operative period.
There is not enough scientific evidence that justifies the routine removal of ovaries during hysterectomy. Ovarian removal leads to decreased estrogen production which leads to the following disadvantages:
The advantage of ovarian removal is decreased risk of ovarian cancer. But it can only be justified for patients with a genetic predispostion to get ovarian cancer. Apart from this high risk group, the advantage of ovarian removal for low risk patients is unclear.
It has been reported in a recent study that when ovaries are removed in low risk patients, there are certain health risks.
You should discuss the pros and cons of ovary removal during hysterectomy with your gynecologist.
It is not recommended routinely to remove healthy ovaries for benign (non-cancerous) pathologies after a certain age group an deven for postmenopausal patients.Because ovaries continue to produce hormons even after menopause. It may only be advantageous to remove healthy ovaries in high risk patients carrying cancer genes such as BRCA.
You may need a hysterectomy for the treatment of the following conditions:
A healthy woman can get a hysterectomy only when there is an increased risk of gynecological cancer due to a genetic predisposition. This genetic predisposition to cancer is caused by the BRCA gene mutation.
It is not recommended to have a hysterectomy for propylaxis against future cancer when a woman is healthy, because just like every surgery, hysterectomy carries some risks and certain complications can occur after surgery.
Average age for hysterectomy patients is 40-50 years.
In contrast to common belief, hysterectomy does not affect sexual life in a negative way. Actually the uterus has nothing to do with sexual functions, its only function is child bearing. Hormones are not affected either, because female hormones are secreted from the ovaries, not the uterus. Menstruations will stop after hysterectomy, but if ovaries are preserved, the patient will not experience menopausal symptoms.
Hysterectomy can be done laporoscopically, which is a closed surgery that uses several 0.5 cm to 1cm incisions on the abdominal wall. It is also known as keyhole surgery or keyhole hysterectomy.
Closed method of hysterectomy is laparoscopic hysterectomy and it is commonly performed by our team in Turkey. Its advantage over traditional open hysterectomy is faster recovery and shorter hospitalisation time. Because the incisions are smaller, patients have less bleeding, less pain, decreased risk of infection and faster recovery making it possible for them to get back to daily activities in a shorter time.
Laporoscopic hysterectomy is the preferred method for most patients unless there is a contraindication such as a uterus that is too big or adhesions around the uterus due to previous surgery or endometriosis.
Uterus sized less than a 4 month pregnant uterus can be removed laporoscopically in general.
Keyhole hysterectomy takes about 1-3 hours in general but it may change from patient to patient.
During keyhole or laparoscopic hysterectomy, several 0.5 to 1 cm incisions are made on the abdominal wall and trochars are inserted through them. The uterus is removed from the vagina after it is cut away from its attachments in the pelvis using special instruments.
Most patients having a hysterectomy for benign gynecological pathologies can have a laporoscopic hysterectomy. But when the uterus is too big or the patient has had several abdominal surgeries, it may not be possible.
Laparoscopic hysterectomy recovery may take around 4-6 weeks after surgery.
Laparoscopic hysterectomy is superior to open surgery in many aspects.
Because the incisions are smaller, recovery takes shorter time with laporoscopic hysterectomy.
Laporoscopic hysterectomy advantages:
Laporoscopic hysterectomy disadvantages:
According to a recent study of 511 patients, almost 95 percent of patients have been succesfully operated by laporoscopic hysterectomy, 5 percent of cases were converted to open surgery due to intraoperative complications.
Robotic or robot-assisted hysterectomy is a minimally invasive surgical procedure to remove the uterus. It is similar to a laparoscopic hysterectomy, small incisions are made on the abdominal wall and instruments are inserted through trocars. The surgeon sitting at a console away from the patient uses robotic technology to control and direct the instruments.
According to ACOG, the safest, least invasive and most cost-effective way of uterin removal for non-cancerous pathologies is vaginal hysterectomy, rather than laparoscopic or open hysterectomy.
Hysterectomy price in Turkey depends on the type of surgery (laparoscoıpic, robotic, vaginal or open surgery) and the hospital chosen for surgery. For a free consultation before surgery you can contact us through e-mail or whatsapp.
Dr. Burcu KaramürselObstetrician, Gynecologist, Genital Esthetic Surgeon in Turkey
