I
HYSTEROSCOPY
PERFORMING A HYSTERECTOMY
Hysterectomy may be performed
through the abdomen or the vagina.
For an abdominal hysterectomy, the
incision is made in the lower abdomen
(see below). In vaginal hysterectomy,
the uterus is removed through an
incision at the top of the vagina.
Site of incision for
abdominal hysterectomy
The incision is made in the lower abdomen
(in this case horizontally) level with the top of
the pubic hair.
F a l l o p i a n t u b e
Incisions
The dotted
lines show the
incisions for
removing only
the uterus.
U t e r u s
O v a r y
S i t e o f
i n c is io n
V a g in a
Abdominal hysterectomy
The uterine vessels are clamped. Traction is
placed on the top of the uterus and the vessels
are tied and then divided. In some cases, the
fallopian tubes are cut and the tubes and
ovaries left in place.
Vaginal hysterectomy
After a vaginal incision is made, the uterus and
cervix are removed. (The ovaries cannot be
removed in a vaginal hysterectomy.) The upper
end of the vagina is repaired by stitching.
i c a l h y s t e r e c t o m y ( i n w h i c h t h e u t e r u s ,
c e r v i x ,
a n d
p e l v i c
l y m p h
n o d e s
a r e
r e m o v e d ) i s p e r f o r m e d .
H y s t e r e c t o m y
m a y
b e
p e r f o r m e d
t h r o u g h t h e v a g i n a o r t h r o u g h a n i n c i -
s i o n
i n
t h e
a b d o m e n .
A
p r o c e d u r e
k n o w n a s l a p a r o s c o p i c a l l y a s s i s t e d v a g i -
n a l
h y s t e r e c t o m y
i s
c a r r i e d
o u t
p a r t l y
t h r o u g h
t h e
v a g i n a
a n d
p a r t l y
u s i n g
m i n i m a l l y i n v a s i v e s u r g e r y
.
V a g i n a l h y s t e r -
e c t o m y h a s t h e a d v a n t a g e o f n e e d i n g n o
e x t e r n a l
i n c i s i o n ,
a n d ,
a s
a
r e s u l t ,
t h e
p a t i e n t
u s u a l l y
r e c o v e r s
m o r e
r a p i d l y .
H o w e v e r , a v a g i n a l h y s t e r e c t o m y c a n n o t
b e p e r f o r m e d i f t h e u t e r u s i s s i g n i f i c a n t -
l y e n l a r g e d o r i f t h e h y s t e r e c t o m y i s a
t r e a t m e n t f o r c a n c e r .
RECOVERY AND OUTLOOK
A f t e r t h e o p e r a t i o n , a d r a i n a g e t u b e m a y
b e i n s e r t e d a t t h e s i t e o f t h e i n c i s i o n t o
a i d h e a l i n g . F o r a f e w d a y s t h e r e m a y b e
s o m e v a g i n a l b l e e d i n g a n d d i s c h a r g e , a s
w e l l a s t e n d e r n e s s a n d p a i n . A v a g i n a l
h y s t e r e c t o m y r e q u i r e s a s h o r t h o s p i t a l
s t a y ; a n y f u r t h e r s t a y d e p e n d s o n t h e a g e
a n d h e a l t h o f t h e w o m a n a n d w h e t h e r
t h e r e
a r e
a n y
p o s t o p e r a t i v e
p r o b l e m s .
F u l l r e c o v e r y u s u a l l y t a k e s b e t w e e n t h r e e
a n d s i x w e e k s ; s e x u a l i n t e r c o u r s e c a n b e
r e s u m e d a b o u t a
m
o n t h a f t e r s u r g e r y .
T h e r e c o v e r y p e r i o d a f t e r a n a b d o m i n a l
h y s t e r e c t o m y
m a y b e l o n g e r
a n d m a y
a l s o r e q u i r e a l o n g e r s t a y i n h o s p i t a l .
F o l l o w i n g a h y s t e r e c t o m y , a w o m a n
i s u n a b l e t o b e a r c h i l d r e n ; s h e d o e s n o t
h a v e
m e n s t r u a l
p e r i o d s
a n d
d o e s
n o t
n e e d t o u s e c o n t r a c e p t i o n . I f a w o m
a n ’s
o v a r i e s h a v e a l s o b e e n r e m o v e d b e f o r e
o r
a r o u n d
t h e
w o m
a n ’s
m e n o p a u s e ,
h o r m o n e r e p l a c e m e n t t h e r a p y
( H R T ) m a y
b e
g i v e n .
I t
i s
n o t
u n c o m
m o n
f o r
a
w o m a n t o s u f f e r f r o m d e p r e s s i o n a f t e r
a h y s t e r e c t o m y i f s h e h a s n o t n o t a d e -
q u a t e l y c o u n s e l l e d b e f o r e h a n d .
h y s te ria
A n o l d - f a s h i o n e d t e r m e n c o m p a s s i n g a
w i d e r a n g e o f p h y s i c a l o r m e n t a l s y m p -
t o m s t h a t a r e a t t r i b u t e d t o m e n t a l s t r e s s .
S y m p t o m s f o r m e r l y g r o u p e d u n d e r t h i s
t e r m a r e n o w i n c l u d e d i n t h e m o r e s p e -
c i f i c d i a g n o s t i c c a t e g o r i e s o f
c o n v e r s i o n
d i s o r d e r
;
s o m a t i z a t i o n d i s o r d e r ; d i s s o c i a -
t i v e d i s o r d e r s
;
a n d
f a c t i t i o u s d i s o r d e r s
.The
t e r m
i s
s t i l l
u s e d
l o o s e l y
t o
d e s c r i b e
i r r a t i o n a l b e h a v i o u r .
h y s te ro c o n tra s t s o n o g ra p h y
(H y C o S y )
U l t r a s o u n d
e x a m i n a t i o n
o f t h e
u t e r i n e
c a v i t y a n d t h e f a l l o p i a n t u b e s . A
c o n t r a s t
m e d i u m
v i s i b l e o n u l t r a s o u n d i s i n t r o -
d u c e d i n t o t h e u t e r i n e c a v i t y t h r o u g h
t h e v a g i n a a n d t h e c e r v i x . H y s t e r o c o n -
t r a s t s o n o g r a p h y i s a t e c h n i q u e t h a t i s
u s e d t o i n v e s t i g a t e
i n f e r t i l i t y
;
t h e a d v a n -
t a g e
t h a t
t h i s
m e t h o d
h a s
o v e r
h y s t e r o s a l p i n g o g r a p h y
i s t h a t i s d o e s n o t
i n v o l v e
X - r a y s
.
h y s te ro s a lp in g o g ra p h y
A n
X - r a y
p r o c e d u r e
i n
w h i c h
a
d y e
(
r a d i o p a q u e
c o n t r a s t m e d i u m )
i s i n t r o -
d u c e d
i n t o
t h e
c a v i t y
o f
t h e
u t e r u s
t h r o u g h t h e
c e r v i x
t o m a k e t h e u t e r u s
a n d
f a l l o p i a n
t u b e s
v i s i b l e
o n
X - r a y s .
H y s t e r o s a l p i n g o g r a p h y i s u s e d t o i n v e s -
t i g a t e
i n f e r t i l i t y
.
Hysterosalpingography
This image shows the uterus (centre) and fallopian
tubes. The right tube (left on image) is blocked near
the uterus, allowing no contrast medium into it; the
other is obstructed further down and has dilated.
h y s te ro s c o p y
A t e c h n i q u e t h a t u s e s a h y s t e r o s c o p e ( a
t y p e o f
e n d o s c o p e )
t o v i e w t h e i n s i d e o f
t h e
u t e r u s
a n d
f a l l o p i a n t u b e s
f o r
t h e
p u r p o s e s o f d i a g n o s i n g d i s o r d e r s . H y s -
t e r o s c o p y c a n b e p e r f o r m e d u n d e r l o c a l
a n a e s t h e s i a
.
M
i n o r s u r g e r y , s u c h a s t h e
r e m o v a l
o f
f i b r o i d s
( n o n c a n c e r o u s
t u -
m o u r s o f t h e u t e r u s ) , m a y a l s o b e p e r -
f o r m
e d u s i n g a h y s t e r o s c o p e .
H
405
previous page 404 BMA A Z Family Medical Encyclopedia   2004 read online next page 406 BMA A Z Family Medical Encyclopedia   2004 read online Home Toggle text on/off