Chapter 97 - Abdominal hysterectomy

Summary

Hysterectomy is the most common major gynecologic operation and the second most common major surgical procedure in the USA. More than half a million women undergo hysterectomy each year. It is estimated that by age 65, one third of women will have had their uteri surgically removed. In recent years, alternatives for treating gynecologic disease have decreased the number of hysterectomies performed. Improved systemic hormonal therapies, progestational intrauterine devices, and endometrial ablation techniques have effectively managed menorrhagia without removal of the uterus. Leiomyomas can now be treated with transcervical hysteroscopic resection or uterine artery embolization. In addition, minimally invasive surgery using laparoscopic and laparoscopic-robotic techniques are becoming increasingly common, replacing the traditional abdominal hysterectomy.

Simple total abdominal hysterectomy involves the removal of the uterine corpus and cervix through an abdominal incision. It is performed for a variety of indications including uterine leiomyomas, recurrent dysfunctional uterine bleeding, adenomyosis, chronic pelvic pain, pelvic abscesses, and pelvic organ prolapse. In addition, simple abdominal hysterectomy is performed for three malignant indications: adenocarcinoma of the endometrium, ovarian cancer, and early microinvasive cervical cancer. Preoperative bowel preparation facilitates exposure and reduces trauma to the bowel caused by retraction and packing. Transfusion for simple abdominal hysterectomy is rare, and the operative time is 1 to 2 hours. General anesthesia is usually chosen, although spinal anesthesia can be used.