HYSTERECTOMY​

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Hysterectomy (surgical removal of the uterus) was first successfully performed in the 19th century using vaginal or abdominal incisions Innovations in technology led to the performance of the first laparoscopic hysterectomy in 1989. According to United States national surveillance data, the laparoscopic mode of access has become the most common approach to hysterectomy, with a shift toward day care procedures

Total Laparoscopic Hysterectomy is the standard approach to all benign and selected malignant gynecological diseases.

When a hysterectomy:

  1. Leiomyomas: For symptomatic fibroids, hysterectomy provides a permanent solution to menorrhagia and the pressure symptoms related to an enlarged uterus.
  2. Abnormal uterine bleeding: Endometrial lesions must be excluded and medical alternatives should be considered as a first line of therapy.
  3. Endometriosis: Hysterectomy is often indicated in the presence of severe symptoms with failure of other treatments and when fertility is no longer desired.
  4. Pelvic relaxation: A surgical solution usually includes vaginal hysterectomy, but must include pelvic supporting procedures or a laparoscopic hysterectomy with suspension procedures.
  5. Pelvic pain: A multi-disciplinary approach is recommended, as there is little evidence that hysterectomy will cure chronic pelvic pain. When the pain is confined to dysmenorrhea or associated with significant pelvic disease, hysterectomy may offer relief.
  6. Pre-invasive Disease :Hysterectomy is usually indicated for endometrial hyperplasia with atypia. Cervical intraepithelial neoplasia in itself is not an indication for hysterectomy. Simple hysterectomy is an option for treatment of adenocarcinoma in situ of the cervix when invasive disease has been excluded.
  7. Invasive Disease Hysterectomy is an accepted treatment or staging procedure for endometrial carcinoma. It may play a role in the staging or treatment of cervical, epithelial ovarian, and fallopian tube carcinoma.
  8. Tubo-ovarian abscesses that are ruptured or do not respond to antibiotics may be treated with hysterectomy and bilateral salpingo-oophorectomy in selected cases.
  9. Hysterectomy may be required for cases of acute menorrhagia refractory to medical or conservative surgical treatment.