Hysterectomy

Every woman stands a risk of 1 in 3 by the age of 60 yrs of undergoing a hysterectomy operation

Hysterectomy – an operation for removal of a womb/uterus-is by far a commonest gynecological operation performed on women world wide.

Hysterectomy is performed for

  • Excessive an prolonged menstrual bleeding not responding to medications
  • Fibroid uterus
  • Adenomyosis
  • Endometriosis
  • Pre malignant lesion of cervix and malignancy (cancer)

Modern medicine has developed many therapeutic options for avoiding hysterectomy. Still a significant number of women need to undergo this operation due to failure of other conservative options. Also many women prefer to undergo hysterectomy as it offers a definite solution to get rid of troublesome symptoms.

Considering involvement of modern day woman in all aspects of life, absence from active life for this operation for a significant duration is unacceptable.

Due to peculiar anatomical location of uterus in female body, hysterectomy can be performed by two routes – abdominally and vaginally. Abdominally the operation may be done by laparatomy (opening of abdomen by a large incision) or endoscopially (laparoscopy). Although endoscopy is a much publicised route at present it is not the best one. Many studies world over have proved beyond doubt that vaginal hysterectomy is the best way of performing this operation and should be the preferred route for all hysterectomy operations as far as possible.

Fortunately, hysterectomy can be performed vaginally in at least 85% of patients undergoing this operation if a gynecologist is well versed with this technique. There are immense advantages of undergoing this operation vaginally as-

  • No scar hence less painful post operative period
  • Early ambulation
  • Minimal hospitalization
  • Shorter duration of surgery
  • Fast recovery
  • Less cost

Many complications of surgery are secondary to prolonged surgical anaesthesia, prolonged bed ridden condition post operatively.

All such complications are avoided by the use of this route of surgery hence this operation is a “Minimal Access Surgery” in true sense of this terminology.

Laparotomy

Abdominal hysterectomy by opening up abdomen is an age old method of surgical therapy. But with advancement of endoscopy as a devoted stream of surgery requirement of laparotomy for many operative procedures has become debatable. Hysterectomy is one of them. Since there are many disadvantages to this type of operation as

  • Prolonged anaesthesia time
  • More blood loss
  • Painful postoperative period
  • Chances of formation of blood clots in blood vessels due to prolonged bed ridden position
  • Prolonged hospitalization
  • Prolonged recovery time for resuming active life
  • Delayed complications of incision as hernia are possible

Unfortunately despite availability of better option, hysterectomies are being performed abdominally worldwide. In fact 70% of such operations are done by laparotomy all over world due to lack of training of gynecologists in other routes of performing hysterectomy.

Hysterectomy by laporotomy should be restricted only for operation done for malignancy and very big uteri where other routes are contraindicated

Laparoscopy

With advancement of endoscopy as a stream of surgical therapy, many operations especially gynecological can be performed by laparoscopy. Laparoscopic operations have many advantages as

  • Minimal anatomical damage
  • Shorter hospitalization
  • Less painful
  • Shorter recovery time
But few disadvantages are
  • Prolonged operative time
  • Requirement of devoted setup
  • Anaesthesia complications due to prolonged general anaesthesia

Vaginal hysterectomy

With development of endoscopy and with more and more uteri being removed laparoscopically, quest for lesser and lesser invasive options are sought by gynaecologists. This quest for the best has led to revisit to a surgical procedure which was long forgotten due to glamour of competitive options. Vaginal hysterectomy was first performed by Soranus of Ephesus in 2nd century AD. The technique has evolved since then. It is a proud heritage for Indians as many Indian gynaceologists have not only kept the tradition alive but have improved its technique. Dr. V.N Shirodkar, Dr. B N Purandare and many other have strongly promoted this route of hysterectomy worldwide. Dr. Shirish Sheth is continuing this tradition today.

Painless hysterectomy

Pain, although unpleasant in nature is unavoidable aspect of life. Probably that is why we are taught by our ancestors “No pain. No gain”

Medical therapy aims at relieving physical pain for humans and to make them happy. But paradoxically medical therapies sometimes become a cause of pain, at least for a brief period. In surgical therapies, post operative pain is a major concern. But there is now one procedure which can be called as relatively painless- a biclamp hysterectomy.

This is a vaginal hysterectomy performed using an advanced technology known as ‘Vessel sealing technology’. The technique is similar to traditional method of hysterectomy, but the state of the art equipment is used for ‘sealing’ bleeding vessels and pedicles rather than ligating them with thread. ‘Sealing’ is also known as “hot melt” as tissue to be sealed is heated up by a special instrument known as a biclamp which leads to melting of collagen in blood vessel wall. This melting of collagen forms a “seal” on cooling down to normal temperature avoiding need for threads. This results in less operative time, less manipulations, less tissue insult during surgery and hence less post operative pain. As less time is required minimum anesthesia is used and patients can literally walk out of recovery room on their own! This makes the procedure a day care procedure hence this type of operation is aptly called – painless hysterectomy. Other names for such procedure are – Stitchless hysterectomy/scarless hysterectomy or day care hysterectomy.

This technology is used quite commonly in Europe by proponents of vaginal hysterectomy for many years. Dr. Wolfgang Zubke in Germany and Dr. Henri Clave in France are using this technology successfully and to complete satisfaction of their patients for many years. Now , this technology with all its benefits is available to you in Pune, India.