Hysterectomy is the surgical removal of the uterus. This may be done for painful, heavy periods (dysmenorrhea or menorrhagia) or for uterine prolapse. Typically, the fallopian tubes are removed at the time of hysterectomy but the ovaries are left in place. The ovaries are supported by ovarian ligaments and will continue to produce estrogen and testosterone in the pre-menopausal patient. The ovaries may be removed in younger patients for intraoperative findings of abnormalities, which is rare. When a hysterectomy is performed for uterine prolapse, it is often done in combination with a vaginal prolapse repair, sacrocolpopexy or uterosacral colpopexy.
Da Vinci Hysterectomy: da Vinci robotic surgery is a less invasive approach to surgical procedures, with smaller incisions and smaller instruments typically resulting in less post-operative pain and quicker recovery time. Da Vinci hysterectomy may done to remove the uterus and the cervix or for a supracervical or partial hysterectomy, leaving the cervix in place. The cervix may be removed if it is elongated or enlarged, contributing to prolapse or for history of abnormal pap smears. At times, the cervix is left in place for added strength to the repair.
Abdominal Hysterectomy: When da Vinci or laparoscopic surgery is not an option secondary to significant enlargement of the uterus, fibroids or for concomitant repairs, the procedure may be done through a pfannenstiel incision.
Vaginal Hysterectomy: Hysterectomy may also be performed through a vaginal incision.This is often the optimal approach in cases of uterine prolapse in which a vaginal prolapse repair is also performed.
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