Our Summary

This research paper is providing guidelines for doctors in France about the best way to conduct a hysterectomy (a surgery to remove a woman’s uterus) when it’s being done for non-cancerous reasons. The paper suggests that the surgery can be done either through the vagina or with a laparoscope (a small tube with a light and a camera that’s inserted through a small cut in the abdomen), even in cases where the uterus is large, the woman has never given birth, or if she’s previously had a c-section. It also suggests that this surgery can be safely performed on obese women. The guidelines recommend that surgeons should have performed at least 30 hysterectomies before they do them on their own and should do at least 10 each year to keep their skills sharp. They don’t recommend any specific way to stitch up the vagina after the surgery. Lastly, they suggest that doctors should check for any risk of cancer before they plan to use a morcellator (a tool that breaks up large masses of tissue into smaller pieces) in the surgery.

FAQs

  1. What are the recommended methods for conducting a hysterectomy for non-cancerous reasons according to this research paper?
  2. What is the recommended experience level for surgeons performing hysterectomies according to these guidelines?
  3. Why is it suggested for doctors to check for any risk of cancer before planning to use a morcellator in the surgery?

Doctor’s Tip

A doctor might tell a patient that after a hysterectomy, it is important to follow the post-operative care instructions provided by the medical team. This may include taking pain medication as prescribed, resting, avoiding heavy lifting, and gradually increasing activity levels as advised. It is also important to attend follow-up appointments to monitor healing and address any concerns. Additionally, the doctor may advise the patient on hormone replacement therapy if necessary to manage menopausal symptoms that may occur after the surgery.

Suitable For

Patients who are typically recommended hysterectomy for non-cancerous reasons include those with:

  1. Chronic pelvic pain or abnormal uterine bleeding that hasn’t responded to other treatments
  2. Uterine fibroids that are causing symptoms such as heavy menstrual bleeding, pelvic pain, or pressure on other organs
  3. Endometriosis that is causing severe pain or affecting fertility
  4. Adenomyosis, a condition where the tissue that lines the uterus grows into the muscular wall of the uterus and causes pain and heavy bleeding
  5. Prolapse of the uterus, where the uterus descends into the vaginal canal
  6. Chronic pelvic inflammatory disease
  7. Uterine polyps or abnormal thickening of the uterine lining (endometrial hyperplasia)
  8. Pelvic organ cancer (such as cervical, ovarian, or uterine cancer) that requires removal of the uterus as part of treatment

It’s important for patients to discuss all treatment options with their healthcare provider before deciding on a hysterectomy, as it is a major surgery with potential risks and long-term effects on overall health and well-being.

Timeline

Before a hysterectomy:

  1. Consultation with a doctor: The patient will meet with a gynecologist to discuss their symptoms and medical history to determine if a hysterectomy is necessary.

  2. Pre-operative testing: The patient may undergo blood tests, imaging studies, and other tests to assess their overall health before surgery.

  3. Preparing for surgery: The patient may be advised to stop taking certain medications, avoid eating or drinking before surgery, and make arrangements for post-operative care.

  4. Surgery: The hysterectomy is performed either through the vagina or with a laparoscope, depending on the patient’s specific condition and the surgeon’s expertise.

After a hysterectomy:

  1. Recovery: The patient will stay in the hospital for a few days after surgery for monitoring and pain management. They will be advised to avoid heavy lifting, strenuous activities, and sexual intercourse for a period of time.

  2. Follow-up appointments: The patient will have follow-up appointments with their surgeon to monitor their healing progress and address any concerns or complications.

  3. Hormone replacement therapy: Depending on the type of hysterectomy performed, the patient may need hormone replacement therapy to manage symptoms of menopause.

  4. Emotional support: The patient may experience a range of emotions after a hysterectomy, and may benefit from counseling or support groups to cope with the physical and emotional changes.

Overall, the timeline of a patient’s experience before and after a hysterectomy involves thorough evaluation, surgical preparation, recovery, and ongoing follow-up care to ensure a successful outcome.

What to Ask Your Doctor

  1. What are the reasons for recommending a hysterectomy in my case?
  2. What are the different types of hysterectomy procedures available and which one is recommended for me?
  3. What are the risks and potential complications associated with the procedure?
  4. What is the recovery time and what can I expect during the recovery process?
  5. Will I need hormone replacement therapy after the surgery?
  6. Will the surgery affect my sexual function or libido?
  7. How will the surgery impact my future fertility?
  8. How often does the surgeon perform hysterectomies and what is their experience with this procedure?
  9. Are there any alternative treatment options available for my condition?
  10. What follow-up care will be required after the surgery?

Reference

Authors: Gauthier T, Huet S, Marcelli M, Lamblin G, Chêne G; French College of Obstetrics and Gyneacology (CNGOF). Journal: J Gynecol Obstet Biol Reprod (Paris). 2015 Dec;44(10):1168-82. doi: 10.1016/j.jgyn.2015.09.032. Epub 2015 Oct 31. PMID: 26527018