Hysterectomy is the second most performed surgical procedure after cesarean section for women of reproductive age in the United States according to the Center for Disease Control and Prevention. Approximately 600,000 hysterectomies are performed annually and 20 million American women have had one.
A hysterectomy is a surgery to remove a women’s uterus. There are several a doctor could recommend. They range from a partial hysterectomy which removes the body of the uterus while leaving the cervix in place to a radical hysterectomy which removes the uterus, cervix, ovaries, fallopian tubes and possible upper portions of the vagina and affected lymph glands.
Today, during a hysterectomy it is now recommended that the fallopian tubes be removed as well as a preventative health measure to reduce the risk of cancer.
“A woman’s lifetime risk of ovarian cancer is around one percent, that means that over the course of 100 women’s lifetimes, one of them will get ovarian cancer. We care about this cancer because it is very hard to catch early,” says Dr. Chad Thomas.
Dr. Thomas specializes in Obstetrics and Gynecology at PeaceHealth in Bellingham. He has observed the shift away from abdominal hysterectomies and the move toward minimally invasive hysterectomies, along with the recommendation of removing fallopian tubes during the surgery.
He explained that pathologists look at the fallopian tubes removed during hysterectomies for other reasons and would occasionally discover what looked like very early ovarian cancer in the tubes. However, when they checked the ovaries, there would be no cancer.
“Cancers we’ve historically called ‘ovarian cancers’ are both ovarian cancers and fallopian tube cancers and about half of them start in the fallopian tubes,” says Dr. Thomas. “Fallopian tubes are like highways, they connect the ovaries down to the uterus. That’s really what their job is and if you’re not needing your ovaries connected to your uterus any more, than it makes sense to take them out to reduce the risk of ovarian cancer.”
It takes an extra five minutes to remove the fallopian tubes during the hysterectomy and there is not a lot of extra risk associated with it, according to Dr. Thomas. Removing the tubes doesn’t change hormones or put women into early menopause. It is a procedure that doesn’t increase risk or side effects of the surgery and leads to a more positive outcome.
“We’ve developed other minimally invasive means of doing hysterectomies such as laparoscopic hysterectomies,” says Dr. Thomas. “For patients [minimally invasive surgeries] are a really good thing because the smaller the incision, the faster the recovery.”
When talking to your doctor about surgical procedures for hysterectomies, there are a few possibilities that might be discussed. A vaginal hysterectomy is a procedure in which the uterus is removed through the vagina. A laparoscopic-assisted vaginal hysterectomy employs a lighted tube (laparoscope) which helps the doctor see the organs that hold the uterus in place. This tool is used to provide the surgeon greater visibility to remove the uterus through the vagina. Finally, a robotic-assisted laparoscopic hysterectomy has the laparoscope inserted and the surgeon performs the procedure from a remote-controlled area.
In an abdominal hysterectomy, the surgeon cuts an incision like a cesarean section to remove the uterus and other organs. This has a longer recovery time. A laparoscopic-assisted abdominal hysterectomy has a shorter recovery time.
“Ask your doctor if they can do it vaginally or laparoscopically because there’s so much benefit to that over abdominal and the safety profiles have really gotten to the point where it’s at least as safe, if not safer, to do a hysterectomy minimally invasively than through an abdominal incision,” says Dr. Thomas.
Dr. Thomas also explained that while there are better options for getting a hysterectomy now, he’s discovered that many times they’re able to treat whatever the symptoms are and avoid the hysterectomy entirely which he says may be the best outcome of all.
There is a lot to understand about surgeries and which is right for you. what other treatments can be used for your condition, what hysterectomy options are available to you and how well hysterectomy is likely to work for you.