Hysterectomy

Hysterectomy (from Greek hystera – uterus, ektomē – removal) is a radical surgical intervention consisting in the removal of the uterus. It is one of the most frequently performed cavity operations in operative gynecology.

Etiology and pathophysiology

The classification of surgery depends on the extent of resection:

• Subtotal hysterectomy (supravaginal amputation): Only the body of the uterus is removed, the cervix is preserved. It is only possible if there is no cervical abnormality and smears are normal.
• Total hysterectomy (extirpation): The uterus is removed in a single block along with the cervix.
• Radical hysterectomy (Wertheim’s operation): Extended removal of the uterus, upper third of the vagina, parametrial tissue, and regional lymph nodes (cancer standard). Access can be laparotomic (incision), laparoscopic (punctures), or vaginal (through the vagina, without incisions in the abdomen).

Clinical significance

Surgery is indicated when organ-saving methods are ineffective or impossible: in symptomatic multiple myomas of giant size (more than 12-14 weeks), diffuse nodular adenomyosis with anemic bleeding, atypical hyperplasia, endometrial cancer, as well as prolapse of the genitalia. Hysterectomy leads to irreversible loss of reproductive function. If the ovaries are preserved, the hormonal background of a woman does not suffer dramatically, but the risk of menopause 3-4 years earlier increases due to the disruption of blood supply to the gonads.