HYSTERECTOMY A hysterectomy is the surgical removal of the uterus, usually performed by a gynecologist.

Sometimes a hysterectomy includes removal of one or both ovaries and fallopian tubes. It is the most commonly performed gynecological surgical procedure. TYPES Radical Hysterectomy complete removal of the uterus, cervix, upper vagina, and parametrium. Indicated for cancer. Lymph nodes, ovaries, and fallopian tubes are also usually removed in this situation. Total Hysterectomy complete removal of the uterus and cervix, with or without oophorectomy. This is the most commonly performed operation. Total Hysterectomy with Bilateral/Unilateral Salpingo-Oophorectomy removal of the uterus, cervix, one or both fallopian tubes (salpingectomy), and one or both ovaries (oophorectomy). Subtotal (Supracervical) Hysterectomy removal of the uterus, leaving the cervix in place.

SURGICAL TECHNIQUES Abdominal Hysterectomy It is an open surgery. The most common approach to hysterectomy. The surgeon makes a 5 to 7 inch incision, either up-and-down or side-toside, across the belly. The surgeon then removes the uterus through this incision. Vaginal hysterectomy The surgeon makes a cut in the vagina and removes the uterus through this incision. The incision is closed, leaving no visible scar. Laparoscopic hysterectomy This surgery is done using a laparoscope, which is a tube with a lighted camera, and surgical tools inserted through several small cuts made in the belly. The surgeon performs the hysterectomy from outside the body, viewing the operation on a video screen. Laparoscopic-assisted vaginal hysterectomy Using laparoscopic surgical tools, a surgeon removes the uterus through an incision in the vagina. Robot-assisted laparoscopic hysterectomy This procedure is similar to a laparoscopic hysterectomy, but the surgeon controls a sophisticated robotic system of surgical tools from outside the body. Advanced technology allows the surgeon to use natural wrist movements and view the hysterectomy on a three-dimensional screen.

INDICATIONS Hysterectomy is normally recommended as a last resort to remedy certain intractable uterine/reproductive system conditions. Such conditions include, but are not limited to: a. Certain types of reproductive system cancers (uterine, cervical, ovarian, endometrium) or tumors, including uterine fibroids that do not respond to more conservative treatment options. b. Severe and intractable endometriosis (growth of the uterine lining outside the uterine cavity) and/or adenomyosis (a form of endometriosis, where the uterine lining has grown into and sometimes through the uterine wall musculature), after pharmaceutical or other surgical options have been exhausted. c. Chronic pelvic pain, after pharmaceutical or other surgical options have been exhausted. d. Postpartum to remove either a severe case of placenta previa (a placenta that has either formed over or inside the birth canal) or placenta percreta (a placenta that has grown into and through the wall of the uterus to attach itself to other organs), as well as a last resort in case of excessive obstetrical hemorrhage. e. Several forms of vaginal prolapse. COMPLICATIONS Hysterectomy is a low-risk surgery. Most women who undergo hysterectomy have no serious problems or complications from the surgery. However, as with any surgery, hysterectomy can result in complications for a small minority of women. Those complications include: a. b. c. d. Urinary incontinence Vaginal prolapse (part of the vagina coming out of the body) Fistula formation (an abnormal connection that forms between the vagina and bladder) Chronic pain

Other risks from hysterectomy include wound infections and blood clots, although these are uncommon. SURGICAL MENOPAUSE If the ovaries are removed during a hysterectomy, the woman will go through menopause immediately after the operation, regardless of her age. Thus, hormone replacement therapy will be offered. If one or both of the ovaries are left intact, there's a chance the woman will experience menopause within five years of having her operation.

NURSING MANAGEMENT a. Assess for signs of hemorrhage. Hemorrhage is more common after vaginal hysterectomy than after abdominal hysterectomy. b. Monitor vital signs every 4 hours, auscultate lungs every shift and measure intake and output. These data are important indicators of hemodynamic status and complications. c. Once the catheter has been removed, measure the amount of urine voided. d. Assess for complications, including infection, ileus, shock or hemorrhage, thrombophlebitis, and pulmonary embolus. e. Assess vaginal discharge; instruct the woman in perineal care. f. Assess incision and bowel sounds every shift. g. Encourage turning, coughing, deep breathing, and early ambulation. h. Encourage fluid intake. i. Teach to splint the abdomen and cough deeply. Teach the use of the incentive spirometer. j. Instruct to restrict physical activity for 4 to 6 weeks. Heavy lifting, stair climbing, douching, tampons, and sexual intercourse should be avoided. The woman should shower, avoiding tub baths, until bleeding has ceased. Infection and hemorrhage are the greatest postoperative risks; restricting activities and preventing the introduction of any foreign material into the vagina helps reduce these risks. k. Explain to the woman that she may feel tired for several days after surgery and needs to rest periodically. l. Explain that appetite may be depressed and bowel elimination may be sluggish. These are aftereffects of general anesthesia, handling of the bowel during surgery, and loss of muscle tone in the bowel while empty. m. Teach the woman to recognize signs of complications that should be reported to the physician or nurse: Temperature greater than 37.7C Vaginal bleeding that is greater than a typical menstrual period or is bright red Urinary incontinence, urgency, burning, or frequency Severe pain n. Encourage the woman to express feelings that may signal a negative self-concept. Correct any misconceptions. Some women believe that hysterectomy means weight gain, the end of sexual activity, and the growth of facial hair. o. Provide information on risks and benefits of hormone replacement therapy, if indicated. If the ovaries have also been removed, the woman is immediately thrust into menopause and may want or need hormone replacement therapy. p. Reinforce the need to obtain gynecologic examinations regularly even after hysterectomy.