Gynaecologist & Endoscopic Surgeon

Hysterectomy

  • Hysterectomy
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  • 1. What is a hysterectomy?
     

    Hysterectomy involves surgically removing the uterus (womb).
    There are many reasons for having an hysterectomy including heavy bleeding, fibroids, adenomyosis, infection, endometriosis or cancer.
    The most common method involves removing the uterus via an incision in the abdomen (abdominal hysterectomy).
    Vaginal hysterectomy is the term given when the uterus is removed via the vagina with no incisions on the abdomen. This involves the least amount of pain and discomfort for the patient.
    Laparoscopy enables an abdominal hysterectomy to be converted into a procedure where a large cut is avoided. A laparoscopic hysterectomy is major surgery accomplished through minor incisions.

    For further information on hysterectomy, please visit: www.swec.com.au/hysterectomy.html

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  • 2. Vaginal Hysterectomy
     

    Vaginal hysterectomy is the term given when the uterus is removed via the vagina with no incisions on the abdomen.
    Most would agree that the vaginal approach is the quickest and most comfortable for the patient.
    Despite this however, in Australia only some 30% of the 20,000 hysterectomies performed annually are accomplished in this fashion.

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  • 3. Why have an abdominal (open) hysterectomy?
     

    Good question. Most (90%) of all hysterectomies can now be performed without a major abdominal incision and only one to two days in hospital.
    Rare reasons for a large cut include cancer and a very big uterus. By way of comparison it is now extraordinarily rare to have your gallbladder removed via a large incision.

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  • 4. Laparoscopic Hysterectomy
     

    Laparoscopic hysterectomy is major surgery accomplished through minor incisions. Laparoscopy enables an abdominal hysterectomy to be converted into a procedure where a large abdominal cut (incision) is avoided.

    A significant degree of controversy has surrounded the concept of utilising the laparoscope to assist with hysterectomy. The laparoscopic approach may be used to divide pedicles from above, avoiding a large incision and thus allowing the uterus to be removed from below.

    This technique should not be used as an alternative to vaginal hysterectomy, but as a method to allow an abdominal hysterectomy to be converted to a vaginal hysterectomy, or to convert a difficult vaginal hysterectomy to an easy procedure.

    In experienced hands the requirement for abdominal hysterectomy has now dropped considerably. The major drawback to laparoscopic hysterectomy is the difficult learning curve for the surgeon to acquire the necessary skills.

    In experienced hands most hysterectomies can be performed without a large incision. Exceptions include cancer and the very large uterus (extending up to the umbilicus). The potential complications are similar no matter how the hysterectomy is done.

    The laparoscopic approach has less infective complications and avoids the problems of a large cut (wound breakdown, hernia, infection etc).

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Please click on the images below for descriptions and larger images.

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1 year ago
How Does Surgical Volume Affect Gynecologic Surgery Outcomes?

More evidence that low volume surgeons have more problems: https://t.co/gw77JTNAao

Dr Kaunitz suggests an honest self-assessment of our experience level when planning for surgical care of our patients.

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