Hysterectomy: Difference between revisions

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Hysterectomy is the surgical removal of the uterus. <ref>Papadopoulos MS, Tolikas AC, Miliaras DE. Hysterectomy—Current Methods and Alternatives for Benign Indications. Obstetrics and gynecology international. 2010 Jan 1;2010.</ref>It could be performed through the abdominal route, vaginal route, laparoscopically or combined method.<ref>Anbreen F, Qadir S, Naeem H, Farhat N, Ghafoor M, Hassan S. Type, time-trend and indications of hysterectomy. Gomal Journal of Medical Sciences. 2018 Dec 31;16(4):92-6.</ref>
Hysterectomy is the surgical removal of the uterus. <ref>Papadopoulos MS, Tolikas AC, Miliaras DE. Hysterectomy—Current Methods and Alternatives for Benign Indications. Obstetrics and gynecology international. 2010 Jan 1;2010.</ref>It could be performed through the abdominal route, vaginal route, laparoscopically or combined method.<ref>Anbreen F, Qadir S, Naeem H, Farhat N, Ghafoor M, Hassan S. Type, time-trend and indications of hysterectomy. Gomal Journal of Medical Sciences. 2018 Dec 31;16(4):92-6.</ref>
 
[[File:Uterus.jpeg|center|550x550px]]
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* Massive Postpartum Hemorrhage <ref name=":0" /><br>  
* Massive Postpartum Hemorrhage <ref name=":0" /><br>  


== Types of Hysterectomy  ==
== Types of Hysterectomies  ==
 
# Total Abdominal Hysterectomy - Removal of the uterine body and the cervix<ref name=":1">Kives S, Lefebvre G, Wolfman W, Leyland N, Allaire C, Awadalla A, Best C, Leroux N, Potestio F, Rittenberg D, Soucy R. Supracervical hysterectomy. Journal of Obstetrics and Gynaecology Canada. 2010 Jan 1;32(1):62-8.</ref>
# Supracervical Hysterectomy - Removal of the fundus and body of the uterus but excludes the cervix <ref name=":1" />
# Hysterectomies are associated with removal of the ovaries and fallopian tubes ( Bilateral salphingo-oophorectomy)<ref name=":1" />
# Radical Hysterectomy<br>
 
== Surgical Approaches for hysterectomy  ==
 
* Abddominal Hysterectomy<ref name=":2">Aarts JW, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BW, Kluivers KB. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane database of systematic reviews. 2015(8).</ref>  - This route allows inspection of other pelvic organs and surrounding tissue. This route is used for carcinoma or to remove a large fibroid uterus. The uterus is accessed through a Pfannenstiel( Bikini-line) incision.
* Vaginal Hysterectomy<ref name=":2" />- An incision is made in the anterior vaginal wall to access the uterus and cervix. This approach is usually used for non-malignant conditions of the uterus, particularly in cases of uterine prolapse.
* Laparoscopic Hysterectomy<ref name=":2" />  -
* Robotic-assisted Hysterectomy<ref name=":2" />
 
{{#ev:youtube|-YVkY7N8LOc}}<ref>Nucleus Medical Media. Robotic Hysterectomy. Available from: https://www.youtube.com/watch?v=-YVkY7N8LOc</ref>
 
== Complications  ==
 
* Vaginal Cuff Cellulitis<ref name=":3">Clarke-Pearson DL, Geller EJ. Complications of hysterectomy. Obstetrics & Gynecology. 2013 Mar 1;121(3):654-73.</ref>
* Infected Pelvic Hematoma or Abscess<ref name=":3" />
* Wound Infection<ref name=":3" />
* Urinary Tract Infection<ref name=":3" />
* Venous thromboembolism<ref name=":3" />
 
== Physiotherapy Management ==
 
Short Term Goals :
 
# Patient education
# Pain reduction
# Improve the strength of abdominal muscles
# Improve respiratory efficiency
# Bed Mobility
 
Long Term Goals :
 
# Maintain the strength of abdominal muscles
# Maintain the strength of pelvic floor muscles
# Make patient functionally independent


add text here relating to the clinical presentation of the condition<br>


== Diagnostic Tests  ==
Pre-Operative Physiotherapy :


add text here relating to diagnostic tests for the condition<br>
* Patient Education-  Education regarding route of surgery, prognosis, post-surgical complications, the importance of physiotherapy
* To prevent respiratory complications- Active Cycle Breathing Technique (ACBT), Supported coughing
* To increase the strength of pelvic floor muscles - [[Pelvic Floor Exercises|Pelvic floor exercises]] 
* To increase strength in abdominals - Pelvic tilting in crook lying


== Pre-Op  ==
* Mobility - Early ambulation , Bed mobility


add text here relating to the pre-operative advice


== Post-Op  ==
Post Operative Physiotherapy


add text here relating to post-operative rehabilitation<br>  
* <br>  


== Resources <br>  ==
== Resources <br>  ==

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Introduction
[edit | edit source]

Hysterectomy is the surgical removal of the uterus. [1]It could be performed through the abdominal route, vaginal route, laparoscopically or combined method.[2]

Uterus.jpeg


Indication
[edit | edit source]

  • Uterine Leiomyomas[3]
  • Uterine Bleeding[3]
  • Endometriosis[3]
  • Adenomyosis[3]
  • Endometrial hyperplasia[3]
  • Uterine Cancer[3]
  • Pelvic Inflammatory Disease[3]
  • Massive Postpartum Hemorrhage [3]

Types of Hysterectomies[edit | edit source]

  1. Total Abdominal Hysterectomy - Removal of the uterine body and the cervix[4]
  2. Supracervical Hysterectomy - Removal of the fundus and body of the uterus but excludes the cervix [4]
  3. Hysterectomies are associated with removal of the ovaries and fallopian tubes ( Bilateral salphingo-oophorectomy)[4]
  4. Radical Hysterectomy

Surgical Approaches for hysterectomy[edit | edit source]

  • Abddominal Hysterectomy[5] - This route allows inspection of other pelvic organs and surrounding tissue. This route is used for carcinoma or to remove a large fibroid uterus. The uterus is accessed through a Pfannenstiel( Bikini-line) incision.
  • Vaginal Hysterectomy[5]- An incision is made in the anterior vaginal wall to access the uterus and cervix. This approach is usually used for non-malignant conditions of the uterus, particularly in cases of uterine prolapse.
  • Laparoscopic Hysterectomy[5] -
  • Robotic-assisted Hysterectomy[5]

[6]

Complications[edit | edit source]

  • Vaginal Cuff Cellulitis[7]
  • Infected Pelvic Hematoma or Abscess[7]
  • Wound Infection[7]
  • Urinary Tract Infection[7]
  • Venous thromboembolism[7]

Physiotherapy Management[edit | edit source]

Short Term Goals :

  1. Patient education
  2. Pain reduction
  3. Improve the strength of abdominal muscles
  4. Improve respiratory efficiency
  5. Bed Mobility

Long Term Goals :

  1. Maintain the strength of abdominal muscles
  2. Maintain the strength of pelvic floor muscles
  3. Make patient functionally independent


Pre-Operative Physiotherapy :

  • Patient Education- Education regarding route of surgery, prognosis, post-surgical complications, the importance of physiotherapy
  • To prevent respiratory complications- Active Cycle Breathing Technique (ACBT), Supported coughing
  • To increase the strength of pelvic floor muscles - Pelvic floor exercises
  • To increase strength in abdominals - Pelvic tilting in crook lying
  • Mobility - Early ambulation , Bed mobility


Post Operative Physiotherapy


Resources
[edit | edit source]

add appropriate resources here

References[edit | edit source]

  1. ↑ Papadopoulos MS, Tolikas AC, Miliaras DE. Hysterectomy—Current Methods and Alternatives for Benign Indications. Obstetrics and gynecology international. 2010 Jan 1;2010.
  2. ↑ Anbreen F, Qadir S, Naeem H, Farhat N, Ghafoor M, Hassan S. Type, time-trend and indications of hysterectomy. Gomal Journal of Medical Sciences. 2018 Dec 31;16(4):92-6.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Carlson KJ, Nichols DH, Schiff I. Indications for hysterectomy. New England Journal of Medicine. 1993 Mar 25;328(12):856-60.
  4. ↑ 4.0 4.1 4.2 Kives S, Lefebvre G, Wolfman W, Leyland N, Allaire C, Awadalla A, Best C, Leroux N, Potestio F, Rittenberg D, Soucy R. Supracervical hysterectomy. Journal of Obstetrics and Gynaecology Canada. 2010 Jan 1;32(1):62-8.
  5. ↑ 5.0 5.1 5.2 5.3 Aarts JW, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BW, Kluivers KB. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane database of systematic reviews. 2015(8).
  6. ↑ Nucleus Medical Media. Robotic Hysterectomy. Available from: https://www.youtube.com/watch?v=-YVkY7N8LOc
  7. ↑ 7.0 7.1 7.2 7.3 7.4 Clarke-Pearson DL, Geller EJ. Complications of hysterectomy. Obstetrics & Gynecology. 2013 Mar 1;121(3):654-73.
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