Hysterectomy

220px-Scheme_hysterectomy-en.svg (1)WHAT IS IT?

This is the surgical procedure usually performed by a Gynecologist to remove the uterus, or womb. It may be done with or without removal of the ovaries and Fallopian tubes at the same time, called bilateral salpingo-oophrectomy (BSO).

Hysterectomy may be total or complete, which means the body, fundus and cervix are all removed. It may also be a partial or supracervical hysterectomy, in which the upper part of the uterus is removed, leaving the cervix in place. The diagram above shows where cuts are made for each type. There are several different ways to do a hysterectomy:

  • via an abdominal incision, called an open hysterectomy, which allows the surgeon access to the entire pelvic and lower abdominal areas to remove the uterus and ovaries. The incision is similar to a caesarean section, and since it cuts through the muscles of the abdominal wall over a larger area, it requires longer healing and recovery time, typically about six weeks,
  • using a vaginal incision. The uterus and ovaries are removed entirely through the vaginal canal, without any incision in the abdominal wall. Since this is a less invasive way to remove the uterus, it tends to have fewer complications, shorter hospital stay, and faster healing and recovery.
  • minimally invasive techniques using the laparoscope. This method can be laparoscopic-assisted vaginal hysterectomy (total), or laparoscopic-assisted supracervical hysterectomy (partial).
  • minimally invasive robotic hysterectomy, using the DaVinci system with remotely controlled instruments that allow the surgeon precise control as well as three-dimensional, magnified vision. This method uses very tiny incisions (less than 1/2 inch) in the abdominal wall, so recovery and healing is much faster than the other types of hysterectomy.

ARE YOU A CANDIDATE?

Once the uterus is removed, a woman can no longer become pregnant and have a baby, so this surgery is usually done for women after their child-bearing years are finished unless there is a very serious medical reason for it to be done at a younger age.

There are a number of gynecological conditions such as fibroids, endometriosis, adenomyosis, chronic pelvic pain, uterine prolapse or cancers of the uterus/ovaries/cervix or endometrium that may lead to the need for hysterectomy, with or without removal of the ovaries. If these problems cause severe pain, heavy uncontrollable bleeding, uterine or ovarian cancer not relieved by medical or other minor surgeries, then hysterectomy is often recommended. It may also be recommended for women who have a strong family history of uterine, ovarian or breast cancer if there is a positive test for the BRCA1 or BRCA 2 mutations that dramatically increase breast cancer risks.

WHAT BENEFITS CAN I EXPECT?

The biggest benefits women experience are relief from severe pain and heavy bleeding. Another benefit is the relief of worry about future cancers of these organs. Some women describe feeling freer to more fully enjoy sex without a fear of pregnancy. Remember that every woman and every situation are different, responses and benefits vary depending on the symptoms that led to the surgery and whether or not replacement hormone therapy is added after surgery to maintain optimal hormone balance and quality of life.

WHAT ARE THE POSSIBLE RISKS?

If the ovaries are removed with the uterus, women experience immediate menopause, so women will need to discuss hormone replacement therapy to prevent hot flashes, preserve bone, brain acuity, sexual response and many other functions that are regulated by estrogen and testosterone, two of the key ovarian hormones that will need to be added back to prevent unwanted symptoms and decline in quality of life.

It is important to clarify that the biggest reason women complain of problems after hysterectomy is due to the lack of add-back hormones, not the surgery itself. For example, in the United States, only about 15% of women are offered hormone therapy after their surgery. This is a very severe problem and major cause of the loss of sexual function, mood changes, and other problems women describe. In our program, we will evaluate your hormone levels before and after surgery, and discuss options to help you maintain your hormonal balance after surgery to give you the best chance of optimal recovery and wellbeing.

Your risks of developing complications during surgery depends on several key factors: your general health before surgery, the skill of the surgeon and surgical team, the quality of the hospital facility. Any major surgery has potential general risks that we do our best to minimize by carefully evaluating all our patients with medical and surgical review and consultation before you ever leave home to do our best to be sure that:

  • you meet the appropriate criteria for the procedure,
  • you are medically stable to travel and undergo surgery,
  • you are mentally prepared and feel comfortable with your surgeon,
  • your surgeon has the right training and experience to meet your needs,
  • the hospital has all the facilities and equipment to properly carry out the surgery recommended.

Med Expert Chile has selected the leading surgeons in their fields and one of the top private hospitals in Santiago known for its meticulous attention to reducing risks of infection and complications during surgeries. With over 25,000 surgeries in 2013, our partner hospital had a 0.8% infection rate, one of the lowest in the world.

General risks of any major surgery can include, but not limited to, infection, excessive bleeding or blood clots, adverse reactions to anesthesia, inadvertent damage to other tissues surrounding the surgical site, or in very rare cases, disability or death.

Specific risks known to be possible for your particular procedure will be discussed ahead of time by your surgeon.

We do everything possible to reduce these risks and help you feel comfortable and prepared to go forward with surgery.

WHAT DOES IT COST?

We do not sell “Off-the-shelf” surgeries at a fixed cost. We determine the right procedure for each person after our medical-surgical consultation to discuss your best options. A precise cost estimate can only be given after our Medical Director and Surgeons have completely evaluated your specific case and your medical needs and discussed all this with you.

In general, hysterectomy surgery costs approximately 65-70% lower than in the United States. See more information about cost savings and payment options.