Laparoscopic subtotal hysterectomy

About subtotal hysterectomy

A subtotal hysterectomy is an operation to remove your uterus (womb), leaving your cervix (neck of your womb), in place. We may need to remove your ovaries at the same time.

If you decide against a hysterectomy or it is delayed

You may prefer to put up with your symptoms, rather than have the operation. Your gynaecologist will talk to you about the risks of not having the operation.

We will monitor your condition and try to control your symptoms.

Benefits

We will discuss with you why we suggest you consider having a laparoscopic hysterectomy.

A subtotal hysterectomy may cure or remove the following conditions:

• Heavy or painful periods not controlled by other treatments.
• Fibroids, where part of the muscle of your womb becomes overgrown.

The following problems may be better treated by a total hysterectomy, which includes removing your cervix.

• Problems with your cervix.
• Problems with the lining of your womb.
• Endometriosis, where the lining of your uterus grows outside your uterus.
• Adenomyosis, where the lining of your uterus grows into the muscle of your uterus.
• Chronic pelvic inflammatory disease, where inflammation of your pelvis leads to chronic pain and often heavy periods.

A subtotal hysterectomy may cure or improve your symptoms. More than 18 in 20 women will no longer have periods. Others may get a little blood-stained discharge.

However, pain may continue, depending on what causes it.

If we do not remove your ovaries, you may continue to have your usual premenstrual symptoms.

Alternative treatment

A subtotal hysterectomy is a major operation, usually recommended to women after simpler treatments have failed to control their symptoms.

For some women there may be no suitable alternatives and a hysterectomy may be recommended immediately, but this is unusual.

Heavy periods

• We can treat heavy periods using the following methods:
  • A variety of non-hormonal and hormonal oral (by mouth) medicines.
  • An IUS (intra-uterine system). This is an implant containing a synthetic form of the hormone progesterone that fits in your uterus.
  • ‘Conservative surgery’ which removes only the lining of your womb. This is called an endometrial resection.

Fibroids

Depending on the size and position of the fibroids, we can give you medicine to try to shrink them and control the symptoms.

We can also use surgery to remove the fibroids, or shrink the fibroids by reducing their blood supply.

About the operation

We usually perform the operation while you are under a general anaesthetic (asleep). We can also use other anaesthetic techniques.

We may give you injections of local anaesthetic to help with pain, and antibiotics to help reduce the risk of infection.

We will use laparoscopic (keyhole) surgery, which usually leads to less pain, less scarring and a faster return to normal activities.

During the operation [heavily edited]

We empty your bladder using a catheter (tube).

We may examine your vagina.

We may insert an instrument called a manipulator through the neck of your womb (cervix) and into your womb. This allows us to move your womb so we can get a good view of your pelvic area.

We make a small cut, usually on or near your belly button, so we can insert an instrument in your abdominal cavity to inflate it with gas (carbon dioxide). This helps us to view your pelvic area.

We make several small cuts on your abdomen so we can insert tubes (ports) into your abdomen. We insert surgical instruments through the ports, along with a telescope so we can see inside your abdomen.

We separate your womb from the neck of your womb, leaving your cervix in place. We may also separate your fallopian tubes and ovaries from surrounding structures, if they have become stuck together.

We usually remove your womb through one of the small cuts on your abdomen.

We may need to use a special device called a morcellator to reduce the size of fibroids or your womb before removing them. 

We may use diathermy (heat) to treat the lining of your cervix to reduce the risk of bleeding or having a period.

We may need to remove your ovaries, even if this was not originally planned. We will discuss this possibility with you before the operation.​​​​​​​

Sometimes it is not ​​​​​​​possible to complete the operation using keyhole surgery. In this situation, we will use open surgery, which involves a larger cut. This is usually on your ‘bikini’ line or downwards from your belly button (and in some cases from above your belly button).

We may place a catheter in your bladder to help you to pass urine (wee).

We may insert a drain (tube) in your abdomen to drain away fluid that can sometimes collect.​​​​​​​

The operation usually takes about 90 minutes.

After-effects of the operation

You can expect the following after-effects.

• Pain. We will give you medicine to control this. Take it as instructed so that you can move about and cough freely. After keyhole surgery, it is common to have some pain in your shoulders because a small amount of carbon dioxide gas may remain under your diaphragm (a muscle in the chest cavity). Your body will usually absorb the gas naturally over the next 24 hours. This will ease the symptoms.
• Scarring of your skin.
• You will no longer have periods.
• You will not be able to get pregnant.

Complications and risks

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Recovery afterwards

After the operation we will transfer you to the recovery area and then to the ward. We may give you fluid for 12 hours through a drip (small tube) in a vein in your arm.

You will probably feel some pain or discomfort when you wake and we may give you strong painkillers. Pain relief is an important part of your recovery. Tell your healthcare team if you are in pain.

If you have a drip, or a catheter or drain, we usually remove them the same day or the next morning. We will allow you to start drinking and eating light meals. Good nutrition will speed up your recovery.

You will be able to go home when your gynaecologist decides you are medically ready, which is usually the same day or after 1 to 2 days.

You may get a slight discharge or bleeding from your vagina for the first 2 weeks. Tell your healthcare team if this becomes heavy. Use sanitary pads, not tampons.

Nutrition and exercise

We advise you to drink plenty of fluid and increase the amount of fibre in your diet to avoid constipation.

Your healthcare team may recommend exercises to help you to recover. It is important to get out of bed and walk. We may give you breathing or other exercises. Do these, even if you feel you do not want to. They will speed up your recovery.

Look out for symptoms when you return home

Be aware of the following symptoms as they may show that you have a serious complication.

• Pain that gets worse over time or is severe when you move, breathe or cough.
• A heavy discharge or bleeding from your vagina.
• A high temperature or fever.
• Dizziness, feeling faint or shortness of breath.
• Feeling sick or not having any appetite (and this gets worse after the first 1 to 2 days).
• Not opening your bowels and not passing wind.
• Swelling of your abdomen.
• Difficulty passing urine.

Returning to everyday activities

To reduce the risk of a blood clot, follow our instructions if we give you medicine or ask you to wear special stockings.

Rest for 2 weeks and continue to do the gentle exercises we give you. Try to take a short walk every day.

Regular exercise will help you to return to normal activities as soon as possible. Before you start exercising, ask your healthcare team or GP for advice.

Eat healthily, drink plenty of fluid and rest when you need to.

You can return to work once your doctor has said you are well enough to do so. For most people this is after 4 to 6 weeks, depending on the type of work they do.

Most people feel more or less back to normal after 2 to 3 months.

While you recover, do not:

• Do not drive or ride a bike until you are confident about controlling your vehicle, including in an emergency. Check your insurance policy first and speak to your doctor if you have concerns.
• Do not have sex, use tampons or get into the bath, swimming pool or hot tub for at least 12 weeks and before any bleeding or discharge has stopped. When you have sex again, it can be uncomfortable at first and you may need to use a lubricant.
• Do not stand for too long or lift anything heavy.

Menopause and HRT

If your hysterectomy is performed while you are still having periods and your ovaries are removed during the operation, it is likely you will have menopausal symptoms.

These may include hot flushes, night sweats, passing urine more often, a dry vagina, dry skin and hair, mood swings and lack of sex drive. You can usually treat these symptoms with HRT.

Your GP is likely to recommend you take HRT until the time when you would have gone through menopause naturally (at about age 50 to 52). You can carry it on for longer if you want to. Discuss this with your GP.

Most women take HRT in tablet form but it is also available as patches, gels, nasal sprays, vaginal rings and implants. Your GP can discuss these options with you.

If we do not remove your ovaries

Your ovaries should continue to produce the hormones you need until you have reached the normal age of menopause. However, there is some evidence to suggest that some women who have had a hysterectomy may start menopause 2 to 3 years earlier.

After a hysterectomy, it can be more difficult to know when you are in menopause, as your periods will have stopped. You may need blood tests.

If you develop flushes or sweats or other menopausal symptoms, talk to your GP about HRT.