Removal of the uterus (total, radical)

Removal of the uterus (total, radical)

Hysterectomy — total or radical removal of the uterus; performed in gynecologic oncology for cancer and precancerous conditions.

Removal of the uterus is a surgical intervention referred to in medical terms as a "hysterectomy". This operation involves the partial or complete removal of the uterus. In gynecologic oncology, this operation is performed mainly for cancer and precancerous conditions. Hysterectomy is carried out in two main forms — total and radical: a total hysterectomy is the complete removal of the uterus and the cervix, while a radical hysterectomy is the removal of the uterus, the cervix, the surrounding tissues of the uterus (parametrium), the upper part of the vagina and the pelvic lymph nodes. The main indications for the operation are cervical cancer (especially invasive forms), uterine cancer, widely spread or recurrent precancerous conditions (CIN III, endometrial hyperplasia, etc.), invasion of ovarian cancer into the uterus, gynecologic tumors that do not respond to radiotherapy and other treatments, and cases accompanied by bleeding and pain that affect quality of life — only in accordance with the treatment protocol.

How it is performed

The operation can be performed by the open (abdominal) method, the laparoscopic (closed) method or by robotic surgery. During a radical hysterectomy the operation generally lasts 3-5 hours. It begins with access to the abdominal cavity (by the open or laparoscopic route); the internal organs are then assessed and the extent of spread of the pathology is verified. The uterus, the cervix, the surrounding tissues and the lymph nodes are carefully removed, the blood vessels and lymphatic flow are safely cut and ligated, bleeding is controlled and sutures are placed. During the operation, preservation of the organs, avoidance of damage to nerve structures and full adherence to oncological principles are essential conditions.

Preparation

Before the operation, a broad work-up is usually carried out: blood tests, imaging examinations (ultrasound, CT or MRI) and a consultation with the anesthesiologist. Depending on the case, the patient may be advised to stop eating and drinking a few hours before surgery and to temporarily pause certain medications (for example, blood thinners). Bowel preparation and, when necessary, prophylactic antibiotics may be given in line with the surgical plan. When needed, genetic and oncological assessment is also completed in advance.

Recovery

The hospital stay is usually 4-7 days after open surgery and 2-3 days after the laparoscopic method. Pain and discomfort are kept under control during the first days. Nutrition is started a few hours after the operation with light liquid foods. Light physical movements are possible after 1-2 days, and full activity after 4-6 weeks. If the ovaries have also been removed, symptoms of menopause may appear, in which case hormone replacement therapy is discussed. Emotional changes may be observed in women after this operation; both medical supervision and psychological support are beneficial. Regular oncological and gynecologic examinations are important after the operation.

Frequently asked questions