Uterine surgery

Muscle growths, known as fibroids, lead to surgical interventions on the uterus most often. Other reasons for surgery are endometrial lesions in the uterine muscles and cancers of the uterus (uterine carcinoma) or cervix (cervical carcinoma). Depending on the illness and its progression, the uterus is removed completely (hysterectomy) or only parts of the cervix (conisation) or the uterus (trachelectomy) are removed. In women wishing to have children, attempts are made to preserve the uterus during the surgery. This means that it is still possible to get pregnant.

In the case of miscarriages, a curettage is often performed. During the very early weeks of pregnancy, drug therapy is often sufficient.

Removal of the uterus (hysterectomy)

Today, total laparoscopic hysterectomy (removal of the uterus via keyhole surgery) is the most common form of hysterectomy.

Sometimes, the laparoscopy is combined with vaginal access. This method is referred to as laparoscopic-assisted vaginal hysterectomy (LAVH). This involves removing the uterus and cervix through the vagina. Where access only takes place through the vagina, this is referred to as a vaginal hysterectomy. Abdominal hysterectomy, where the abdominal wall is opened, is only performed in exceptional cases.

The following explanations relate to the most common procedure, total laparoscopic hysterectomy.

What preparations are carried out before the procedure?

Various clarifications and examinations are carried out before the intervention. The latter include an ultrasound and vaginal examination. In some cases, a CT or MRI is also carried out. Any blood-thinning medication needs to be paused before the procedure. The surgery is usually performed under general anaesthesia. The usual preparations for anaesthesia take place beforehand.

How is the operation carried out?

To completely empty the bladder, a bladder catheter is first inserted.

The required instruments are then inserted into the abdominal cavity via small incisions in the abdominal wall. The uterus, uterine cervix and cervix are cleared successively and completely removed via the vagina. The connection between the vagina and abdominal cavity is closed with a suture. The intervention takes between one and three hours.

What is the success rate of this procedure?

The results depend on the underlying disease. In the case of fibroids, the illness is cured with surgery.  In the case of cancer, prognosis is determined by the stage of the cancer.

What are the possible complications and risks of this procedure?

The intervention is low-risk and generally runs without any complications. As with all surgeries, however, in rare cases infections, nerve injuries, bleeding or blood clots may occur. Adhesions can sometimes occur in the abdominal cavity. In very rare cases, the ureter can be injured or constricted.

For some women, removal of the uterus is an emotional strain that can also have an impact on their self-image, relationship or sex life.

What happens after the operation?

After the intervention, the anaesthesia recovery phase takes place under monitoring. If everything goes normally, the patient can leave the hospital after two to three days. It is important to avoid heavy physical activity and lifting heavy loads for some time after the surgery, as well as to refrain from sexual intercourse for a while. Depending on the underlying disease, regular follow-up checks may be necessary.

Fibroid removal (myomectomy)

In women wishing to have children, where fibroids cause severe pain and menstrual disorders, the fibroids can be removed while preserving the uterus. Depending on the location of the fibroid, access takes place laparoscopically via the abdominal wall, vaginally or through a combination of both

Conisation

Conisation is an intervention performed in women with a precursor to cervical cancer. In conisation, a small cone is cut out of the cervix. The intervention is usually performed on an outpatient basis under general anaesthesia with access through the vagina.

The intervention usually only takes about 15 minutes. Once all the affected tissue has been removed with conisation, no further treatments are necessary. After conisation, regular check-ups are carried out. Until the wound has healed completely, patients should avoid physical strain and refrain from sexual intercourse.

Trachelectomy

A trachelectomy is performed in women wishing to have children when cervical cancer is confined to the cervix. A trachelectomy involves removing the cervix and a small part of the uterus. It is still possible to get pregnant and give birth via a caesarean section. A trachelectomy is usually performed vaginally with access taking place via the vagina, combined with laparoscopy to remove the lymph nodes.

Hysteroscopy with curettage

A hysteroscopy with curettage is performed to remove polyps and fibroids in the uterine cavity. The intervention is usually performed on an outpatient basis and under general anaesthesia.

The hysteroscope is pushed into the uterine cavity through the vagina to visualise the uterus. With the uterus in view, the polyps or fibroids are removed using a resectoscope. The curette, a sharp spoon, is then used to carefully scrape out the superficial mucous membrane in the uterine cavity. The intervention takes 15 to 30 minutes. After the intervention, the patient should avoid physical exertion and refrain from bathing, swimming and sexual intercourse for about three weeks.

In the case of a medical termination or miscarriage before the tenth week of pregnancy, or a miscarriage or termination after the tenth week of pregnancy, a curettage is also performed if the pregnancy tissue has not been completely expelled.