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A hysterectomy is the surgical removal of the uterus, usually performed by a gynecologist. Hysterectomy may be total (removing the body, fundus, and cervix of the uterus; often called “complete”) or partial (removal of the uterine body while leaving the cervix intact; also called “supracervical”). It is the most commonly performed gynecological surgical procedure. In 2003, over 600,000 hysterectomies were performed in the United States alone, of which over 90% were performed for benign conditions.
Removal of the uterus renders the patient unable to bear children (as does removal of ovaries and fallopian tubes) and has surgical risks as well as long-term effects, so the surgery is normally recommended when other treatment options are not available. It is expected that the frequency of hysterectomies for non-malignant indications will fall as there are good alternatives in many cases.
Hysterectomy, in the literal sense of the word, means merely removal of the uterus. However other organs such as ovaries, fallopian tubes and the cervix are very frequently removed as part of the surgery.
•Radical hysterectomy : complete removal of the uterus, cervix, upper vagina, and parametrium. Indicated for cancer. Lymph nodes, ovaries and fallopian tubes are also usually removed in this situation.
•Total hysterectomy : Complete removal of the uterus and cervix.
•Subtotal hysterectomy : removal of the uterus, leaving the cervix in situ.
Comparison of techniques
The abdominal technique is very often applied in difficult circumstances or when complications are expected. Given these circumstances the complication rate and time required for surgery compares very favorably with other techniques, however time required for healing is much longer.
In direct comparison of abdominal (laparotomic) and laparoscopic techniques laparoscopic surgery causes longer operation time and substantially higher rate of major complications while offering much quicker healing.
Time required for completion of surgery in the eVAL trial is reported as following:
•abdominal 55.2 minutes average, range 19-155
•vaginal 46.6 minutes average, range 14-168
•laproscopic (all variants) 82.5 minutes average, range 10-325 (combined data from both trial arms)