WHY DO I NEED A HYSTERECTOMY?
Hysterectomy means removal of the uterus or womb, the organ responsible for regular menstrual bleeding. It may also often include removal of the tubes and ovaries. Hysterectomy may then be advised for continued heavy or troublesome periods, fibroids or benign tumours of the uterus, prolapse of the uterus often requiring hysterectomy and further repair surgery, pain and other endometriosis related symptoms, pre-cancerous or cancerous changes of the uterus or cervix. It is usually an elective procedure but may be life saving, especially with heavy bleeding or cancerous changes.

WHAT ARE THE ALTERNATIVES?
Heavy bleeding may be treated by hormonal therapy in the first instance or more definitively by an Endometrial Ablation where the lining of the uterus is removed using an electrosurgical current. Both these methods have a failure rate. The only definitive treatment is the removal of the uterus ie. a hysterectomy. For many of the other causes, hysterectomy is the best available method of treatment. Your doctor would be happy to outline the available options to allow you to make the best informed decision.

WHAT TYPES OF HYSTERECTOMY ARE THERE?

Abdominal Hysterectomy: an 8-10 cm cut in the abdomen through which the uterus is removed. This method is suitable when the tubes and ovaries need to be removed as well, or if there is evidence of old scarring or adhesions in the pelvis after previous surgery or endometriosis. It is also the method of choice when the uterus is very bulky eg. with many fibroids.

Vaginal Hysterectomy: Used when the uterus is small or there is prolapse. Because it doesn't involve cuts in the abdomen recovery is faster and less painful. Unfortunately less than 20% of all hysterectomies performed in Australia are done by this method.

Laparoscopic Hysterectomy: The modern technique of Keyhole surgery uses 3-4 small cuts in the abdomen to allow the use of a laparoscope and state-of-the-art operating equipment to change what would have been a abdominal hysterectomy to a vaginal hysterectomy.

WHY USE LAPAROSCOPY?
The laparoscopic approach allows an operation that would have been performed via the abdomen, to be converted to an operation performed via the vagina therefore providing all the benefits of that approach:
• Shorter hospital stays
• Less pain
• Faster recovery
• Faster return to work/normal activity

IS IT SAFE?
All surgery carries risk. Studies have shown that in experienced hands the risk of major complications with laparoscopic hysterectomy is no greater than that of abdominal hysterectomy. These risks include those of anaesthesia, bleeding and the need for transfusion, infection, damage to surrounding organs and blood clots. Minor complications are fewer. It is the role of your surgical team to keep these complications to a minimum.

WHAT HAPPENS BEFORE THE OPERATION?
You will have the opportunity to discuss any further questions with you doctor prior to your operation. You will be asked to sign a consent form, have some routine blood tests and be told about what to eat in the days before surgery. You should also stop taking aspirin or anti-inflammatory medications 9 days before the operation.

WHAT ABOUT IN HOSPITAL?
You will be admitted to hospital on the day of or the night before you operation. Your anaesthetist will see you to discuss the anaesthetic as well as any concerns you may have, and to prescribe a premedication to help you relax before the operation. You will also receive medication to help empty the bowel. The operation itself takes 11/2 -2 hours and you will spend an hour in the recovery ward before returning to your room. During the operation we take great pains to ensure your comfort and care.

HOW LONG WILL I STAY?
Depending on the additional surgery our studies show the average stay after a laparoscopic hysterectomy is less than 3 days. Most patients require only oral pain relief after the first 24 hours and are eating and drinking normally within this period. This contrasts with abdominal hysterectomy where the usual stay is 6-7 days and normal eating /drinking can take 2-3 days!

WHAT ABOUT AT HOME?
Our studies show a return to work/normal activity within 3 weeks compared to 6 weeks after abdominal hysterectomy. This includes driving and normal exercise patterns. Your doctor will answer any of these questions during postoperative visits both in hospital and at the follow-up in the surgery.

WILL MY SEX LIFE BE THE SAME?
Some women do experience emotional effects of surgery and the loss of childbearing capacity and these may impact in the weeks following surgery. Alternatively many women are finally liberated from constant heavy bleeding and the need for birth control, have had uncomfortable prolapse symptoms cured or are free from the pain of their endometriosis. This may often improve their state of mind and subsequently their libido or sex-drive. We advise waiting until the check-up visit with your doctor before resuming sexual activity. For those women before the menopause (or change of life) who have the ovaries removed with their hysterectomy, they may experience symptoms of the menopause including loss of sex drive, vaginal dryness and hot flushes. Your doctor can easily and readily treat these symptoms.