Subtotal hysterectomy

The uterus is the root of women. It is because of the existence of the uterus that women have functions different from men. The existence of the uterus is the foundation for women to have children. The uterus and ovaries will slowly change as women age, and their functions will gradually decline. If the uterus is not well protected, problems are likely to occur. Some serious diseases even require surgical removal of the uterus to be treated. The following introduces subtotal hysterectomy.

Subtotal hysterectomy is indicated for:

1. For young women with uterine fibroids or other benign uterine diseases such as functional uterine bleeding, adenomyoma (disease), etc. who need to have their uterus removed but have normal cervix, the cervix can be retained.

2. There is no serious lesion in the cervix, but the patient's general condition is poor, or there are serious systemic complications and cannot support the more complicated total hysterectomy, or there are extensive adhesions and it is difficult to undergo total hysterectomy.

Contraindications

1. If there are serious lesions in the cervix, such as atypical hyperplasia, severe erosion, or suspicious results in cervical smear cytology examination, it is not advisable to retain the cervix.

2. Patients with malignant transformation of uterine fibroids.

3. Patients with malignant lesions of the endometrium.

4. Patients with concurrent adnexal malignant lesions.

5. Acute pelvic inflammation.

Points to note during surgery

Bleeding

The most common areas of bleeding during hysterectomy are the infundibulopelvic ligament, uterine vessels, and when pushing down the bladder. If the fibroids are too large or too wide, especially when they are located low, they tend to bleed easily, making surgery more difficult. In this case, we must first identify the anatomical relationships and accurately handle the large blood vessels. The operation is usually performed on the side that is easier to operate first. The assistant will try to pull the uterus to the opposite side so that the blood vessels are clearly exposed, the clamps are complete, and the ligatures are secure. After the hysterectomy, the sutures should be checked again or strengthened to prevent bleeding due to loosening of the knots after reduced tissue tension. When cutting the ligament, enough tissue should be left to prevent it from slipping. Treat the bleeding points on all layers of the abdominal wall, especially the muscle layer, to avoid abdominal wall hematoma.