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Hysterectomy, Abdominal

Definition

Total abdominal hysterectomy, or TAH, is a surgery that removes the uterus and cervix through an incision in the abdomen.

Who is a candidate for the procedure?

An abdominal hysterectomy may be done for the following problems:
  • abnormal cells in the lining of the uterus or cervix that are suspicious for very early cancer
  • abnormal or heavy bleeding from the uterus
  • adenomyosis, noncancerous tumors made of gland tissue and muscle
  • chronic pelvic pain
  • endometriosis, a condition in which small pieces of the uterine lining attach to tissue outside the uterus
  • fibroids, which are noncancerous muscle tumors that grow in the wall of the uterus
  • pelvic inflammatory disease, or widespread infection of the pelvic organs
  • uterine prolapse, a condition in which the uterus drops from its normal position at the top of the vagina
Women may also have an abdominal hysterectomy if they suffer from certain types of cancer, such as:
  • cervical cancer
  • uterine cancer
  • fallopian tube cancer, or cancer of the tubes that connect each ovary to the uterus
  • ovarian cancer

How is the procedure performed?

Before surgery, several items of preparation are needed:
  • An intravenous line (IV) is placed in a vein, usually in the hand or arm. The IV can be used to replace fluids and give medicine or a blood transfusion.
  • A urinary catheter is placed in the bladder to drain urine.
  • An anesthesiologist meets with the woman. He or she will discuss possible approaches to anesthesia for the operation, and will take note of any allergies to medicines.
  • Medicines, such as sedatives, are given.
In the operating room, the woman is given either local or general anesthesia. The skin around the vagina and lower abdomen is cleaned with a soapy solution to remove any bacteria and sometimes shaved.
A cut is then made in the lower abdomen, It may go up and down in the middle (a vertical incision) or across at the bikini line (a horizontal incision).
The layers of the abdominal wall are then all cut until the area of the uterus is reached and the uterus, tubes, ovaries and other tissue in the area is examined. The blood vessels that supply the uterus and the supporting tissue around the uterus are cut and sewn with stitches that will later dissolve.
The uterus is removed from the top of the vagina, and the vagina is closed at the top.
The surgery usually takes 60 to 90 minutes. At times, the ovaries and tubes may be removed. Other organs may be repaired or removed as needed.
Other steps may also be needed during the surgery if cancer is found, including:
  • Remove lymph nodes to see if cancer has spread.
  • Fix, alter, or remove other organs.
  • Remove as much cancer as possible.

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