Surgery => Hysterectomy
Hysterectomy, surgical removal of the uterus, the female organ in which a fertilized egg develops into a fetus. The term is derived from the Greek roots hystera, meaninguterus, and ektome, meaning excision. The uterus may be removed for a number of reasons including the presence of cancer, hemorrhaging (excessive bleeding), a condition called prolapse in which the female reproductive organs descend down the birth canal, or the growth of noncancerous abnormal tissue masses called fibroid tumors. Approximately 700,000 hysterectomies are performed annually in the United States. The Centers for Disease Control and Prevention (CDC) estimates that approximately 33 percent of American women will have hysterectomies by the age of 60.
There are several types of hysterectomies. In a total hysterectomy the entire uterus, including the cervix (small organ that connects the uterus and vagina) is removed. In partial hysterectomy the upper portion or body of the uterus is removed, leaving the cervix intact. When the uterus is removed, the surgeon may or may not remove the Fallopian tubes and ovaries. Surgical removal of the fallopian tubes is known as a salpingectomy and removal of the ovaries is called an oophorectomy. A hysterectomy that includes removal of the fallopian tubes and ovaries is referred to as a total hysterectomy with salpingo-oophorectomy.
The uterus may be removed through an abdominal incision, a procedure called an abdominal hysterectomy, or through the vagina, a procedure called a vaginal hysterectomy. Often a physician will use a laparoscope, a narrow, tubular instrument with a fiberoptic light on one end, when performing a hysterectomy. The surgeon inserts the laparoscope through a small incision made just below the navel. The laparoscope enables the surgeon to examine the internal reproductive structures and to operate with small elongated instruments inserted through the laparoscope.
Risks associated with hysterectomy include infections and damage to surrounding structures such as the colon or bladder. Rarely, death from hemorrhage, infection, or anesthetic complications may occur. Complications are more common in women who have had previous surgery or have other serious illnesses.
After a hysterectomy, a woman no longer menstruates and cannot become pregnant. If the ovaries are left in place, they will continue to produce eggs until the onset of menopause, resulting in the emotional and physical symptoms of menstrual cycles without bleeding. Removing the ovaries reduces the risk of ovarian cancer, which is difficult to detect and often fatal. However, a woman should discuss with her physician whether or not the recognized benefits of keeping the ovaries (which may offer protection against heart disease and osteoporosis) outweigh the risks of developing ovarian cancer. If the ovaries are removed, the body no longer produces sex hormones such as estrogen. Most women are then placed on hormone replacement therapy, which supplies synthetic versions of necessary sex hormones to offset the symptoms of menopause. Study results vary about the quality of a woman's life after hysterectomy. Many studies show improvement due to relief from pain and vaginal bleeding, while some show that women who have had a hysterectomy have a higher incidence of depression.
Hysterectomy is a necessary and life-saving surgery to remove cancers of the cervix and uterine lining (endometrium) and to eliminate excessive vaginal bleeding. Its use in the treatment of less serious problems, such as fibroid tumors, is controversial. As a result of this controversy, as well as the development of alternative treatments for reproductive problems, the number of hysterectomies performed in the United States has gradually fallen in recent years.
Hysterectomy rates vary greatly among countries and among regions and hospitals in the United States because of variations in local custom, racial and socioeconomic factors, cancer rates, and access to health care. For example, black women have higher hysterectomy rates for fibroid tumor treatment. Caucasian women typically have higher hysterectomy rates to treat uterine prolapse. Areas in which fee-for-service health-care systems reimburse physicians for performing surgery typically have higher hysterectomy rates than areas in which surgery is only an option in life-threatening cases.