hysterectomy

from Wikipedia, the free encyclopedia
Schematic representation of the extent of different forms of hysterectomy
Vascular supply to the uterus and the adnexa

As a hysterectomy (from ancient Greek ὑστέρα Hystera , uterus, womb ', etymologically related to Latin uterus and " hysteria " and ἐκτομή ektomē , cut, cut') is called the operative removal of the uterus (Latin uterus ). The term uterine extirpation is synonymous ; this expression comes from the Latin uterus 'uterus' and exstirpare ' to tear out', 'to eliminate'. If the ovaries are also removed, the procedure is known as a hysterectomy with adnexa , more precisely with a unilateral or bilateral adnexectomy . In veterinary medicine , pure hysterectomies are practically never performed because they can lead to serious complications. This is called an ovariohysterectomy .

The concept of total extirpation borders while the complete removal of the uterus (total hysterectomy) against the subtotal or supracervical hysterectomy off, in which the cervix (cervix) is maintained. The complete removal of the uterus is often referred to as a total operation . However, the term is not clearly defined with regard to the extent of a hysterectomy and should therefore be misunderstood and should be avoided.

In gynecology , hysterectomy is a common procedure that is mainly performed in benign diseases, to which, however, there are often alternatives.

Indications

Significantly enlarged uterus with multiple fibroids

Removal of the uterus is done for many different reasons. Benign diseases such as benign tumors and functional diseases such as serious menstrual irregularities represent 90 percent of the indications for a hysterectomy. A total of 38.7 percent of all hysterectomies are uterine myomatosus , 17.1 percent endometriosis and 14, 5 percent uterine prolapse is the reason for such an operation.

Up to 2008, 9.4 percent of hysterectomies were due to a malignant disease such as carcinoma of the cervix , uterine body or ovaries . Changes in the uterine lining were the reason for the operation in three percent of the patients.

In addition, a hysterectomy may be necessary in the event of severe injury or inflammation of the uterus and in the case of insatiable bleeding after childbirth .

In Germany, until 2011, a hysterectomy was a prerequisite for a change in civil status in the context of gender reassignment in "woman-to-man transsexuals" in order to restore the permanent infertility required by the Transsexuals Act .

Methods

A distinction is made between a simple removal of the uterus and extended operations such as the already mentioned hysterectomy with adnexectomy, hysterectomy with (pelvic floor) plastics and radical operations for cancer . The choice of the surgical method depends on the indication for the removal of the uterus, any additional interventions required, the size, shape and mobility of the uterus, the equipment in the facility and the surgeon's experience. The use of surgical robots in hysterectomy has not brought better surgical results with an increase in cost.

The concept of radical surgery for separating the complete removal of the uterus (total hysterectomy) from the subtotal or supracervical hysterectomy in which the cervix is retained, it should due to the order implied different ideas about the scale of operation are avoided, since it no clear meaning has and is sometimes used differently and often misleadingly by doctors and laypeople .

Hysterectomy for benign diseases

There are various surgical techniques available today for the complete or partial removal of a uterus:

  • through the vagina (vaginal hysterectomy)
  • laparoscopic hysterectomy (TLH - t otale l aparoskopische H ysterektomie) (first time in 1989 by Harry Reich )
  • combined and laparoscopically through the vagina (LAVH - l aparoskopisch a ssistierte v aginale H ysterektomie, vaginal assisted laparoscopic hysterectomy)
  • laparoscopic removal of the uterus body (LASH - la paroskopische s uprazervikale H ysterektomie)
  • by means of an abdominal incision ( laparotomy ) with preservation of the cervix (subtotal - also supracervical - abdominal hysterectomy)
  • by means of an abdominal incision without preserving the cervix (total abdominal hysterectomy)

With a vaginal removal, the cervix is ​​also removed. This can be retained with laparoscopic and abdominal methods. The simultaneous removal of the ovaries and fallopian tubes ( adnexa ) is always possible with laparoscopic and abdominal access, but should only be done if indicated . In a purely vaginal hysterectomy, removal of the adnexa is also possible in principle, but sometimes more difficult or, in individual cases, not feasible. If the removal is necessary, a different access route is usually chosen. To treat a sagging of the uterus , depending on the cause, either the route through the vagina or the abdomen is chosen, because the additional interventions that are required either also have to be carried out through the vagina or through the abdomen.

  • Uterus before removal by laparoscopy

  • The uterus is separated from the adnexa , the round cervical ligament and the ligamentum latum uteri up to the cervix

  • Pulling out (extraction) of the uterus through the vagina in a total laparoscopic hysterectomy (TLH)

  • Cervical stump (white) after removal of the body of the uterus during laparoscopic supracervical hysterectomy (LASH)

  • Above the vaginal end closed peritoneum at the end of the operation

The number of hysterectomies in Germany has been more or less constant for many years. In 2006, 149,456 hysterectomies were performed. Of these, 126,743 (84.8 percent) were benign changes. Women between the ages of 40 and 49 in particular were affected with around 50 percent of all hysterectomies, women between 50 and 59 made up around 20 percent. This means that almost 70 percent were women in or around the menopause . In 2007, the number of hysterectomies fell to 138,164. In Germany, besides vaginal, abdominal and supracervical hysterectomy, more and more laparoscopic and laparoscopically assisted procedures are coming to the fore.

In Scandinavian countries , between 21 and 36 percent of abdominal hysterectomies are performed as supracervical hysterectomies. In Denmark, the percentage of total abdominal hysterectomies has been reduced by 38 percent within ten years. In 1988 there were 173 such interventions, in 1998 only 107 per 100,000 women were counted each year. However, the percentage of abdominal supracervical hysterectomies increased from 7.5 to 41 per 100,000 women per year over the same period. A total of 67,096 women in Denmark underwent a hysterectomy during these ten years. The theoretical advantages of preserving the cervix, such as the less frequent occurrence of subsidence, urination disorders and problems in the area of sexuality , have not yet been proven in studies. However, there are advantages in terms of operating time, blood loss and complication rates compared to a complete hysterectomy. The risk of developing cervical cancer on the remaining cervical stump is low and, at 0.1 and 0.2 percent, corresponds to the 0.17 percent risk of developing carcinoma of the vaginal stump after a complete hysterectomy. For countries in which there are no early detection programs such as Pap tests and colposcopy , and therefore screening examinations before and after a subtotal hysterectomy cannot be guaranteed, the supracervical hysterectomy is nevertheless not recommended as a standard operation or as a widely applicable alternative to total hysterectomy. With regard to patient satisfaction, the change in sexuality and the self-image of feeling like a woman, no differences between the surgical methods can be demonstrated.

In the United States , around 600,000 hysterectomies are performed annually, most of them by abdominal incision (66 percent), 22 percent vaginally and only 12 percent laparoscopically. The American Congress of Obstetricians and Gynecologists (ACOG), the largest gynecological society in the USA, considers the proportion of abdominal interventions to be far too high and recommends choosing vaginal access more often. The American Academy of Gynecologic Laparoscopists (AAGL) also recommends minimally invasive procedures, such as vaginal or laparoscopic hysterectomy, for benign diseases of the uterus.

The Cochrane Collaboration also recommends that vaginal access be given priority when comparing all hysterectomy methods. If this is not possible, the laparoscopic variants are in the foreground. Abdominal hysterectomy should only be considered if there are reasons against this.

Advantages and disadvantages of the different hysterectomy procedures in comparison
Hysterectomy procedure advantages disadvantage
abdominal hysterectomy
  • not limited by the size of the uterus
  • Combination with lowering and incontinence operations possible
  • longest duration of hospital treatment
  • highest rate of complications
  • longest recovery period
vaginal hysterectomy
  • shortest operation time
  • short recovery period
  • Combination with lowering operations possible
  • Limitation by the size of the uterus and previous operations
  • highest blood loss
  • limited assessability of fallopian tubes and ovaries
laparoscopic supracervical hysterectomy
  • lowest complication rate
  • little blood loss
  • short duration of hospital treatment
  • 10–17% of patients continue to have minimal menstrual bleeding
laparoscopically assisted vaginal hysterectomy
  • Also possible with a larger uterus and after previous operations
  • Combination with lowering operations possible
  • long operation time
  • high instrumental effort by changing the access route
total laparoscopic hysterectomy
  • little blood loss
  • short duration of hospital treatment
  • so far none

Hysterectomy for malignant diseases

The so-called radical hysterectomy according to Wertheim-Meigs (total removal of the uterus with the holding apparatus, the upper third of the vagina and the pelvic lymph nodes) is the standard therapy for some stages of cervical cancer . Alternatively, total mesometrial resection (TMMR) , laparoscopically assisted vaginal radical hysterectomy (LAVRH), and laparoscopic radical hysterectomy (LRH) are available today . The sole radical vaginal total extirpation of the uterus ( Schauta-Stoeckel operation ) without removing the pelvic lymph nodes no longer appears to be indicated today.

If you still want to have children, a radical hysterectomy can in some cases be dispensed with in the early stages of cervical cancer and a radical trachelectomy can be considered. Only large parts of the cervix are then removed, but the cervix and uterine body as such are retained. A lymph node removal that is also necessary can be performed using a laparoscopy. In this case, fertility is basically preserved.

While the adnexa can be dispensed with in squamous cell carcinoma of the cervix in young women, in the case of endometrial carcinoma of the uterine body these must be removed in any case. In ovarian cancer , hysterectomy with both adnexa is also part of the treatment.

The classification according to Piver or Rutledge-Piver, named after the American gynecologists M. Steven Piver and Felix Rutledge, distinguishes five degrees of radicality of a hysterectomy in cervical cancer:

Piver classification
Piver stage designation Extension of the intervention
I. extra fascial hysterectomy
  • no significant mobilization of the ureters
II modified radical hysterectomy

Ultimately, it is an extrafascial hysterectomy with resection of the parametria medial to the ureters.

III “Classic” radical hysterectomy
  • Dissection of the uterine artery at its origin ( internal iliac artery or superior vesical artery )
  • Separation of the sacrouterine and cardinal ligaments close to their origins (sacrum, pelvic wall)
  • Resection of the upper third of the vagina (up to half)
  • Exposing and presenting (dissection) of the ureter up to the point where it joins the urinary bladder while protecting a small lateral portion of the pubovesical ligament
IV advanced radical hysterectomy like Piver III, but with
  • Complete detachment of the ureters from the pubovesical ligament
  • Resection of the superior vesical artery
  • Resection of up to three quarters of the vagina
V - like Piver IV, but additionally
  • Resection of parts of the urinary bladder and the lower part of the ureter with re-suturing (re-implantation) of the ureter

Also removal of fallopian tubes and ovaries

In veterinary medicine pure hysterectomies are unusual because they can lead to serious complications.

For a long time, women were advised to remove their ovaries at the same time as having a hysterectomy for benign diseases in order to prevent ovarian and breast cancer . Women with ovaries removed are a quarter less likely to develop breast cancer and have a 96 percent lower risk of ovarian cancer. However, lung cancer and coronary artery disease are more likely to occur if both ovaries are removed than if they are preserved. Increased femoral neck fractures , cases of Parkinson's disease and dementia are also known and are attributed to decreased estrogen production. Therefore, in women under 65 years of age with no familial risk of ovarian or breast cancer, ovarian preservation in conjunction with hysterectomy should be considered until the benefit of this additional procedure can be demonstrated.

Removing the fallopian tubes as part of a hysterectomy lowers the risk of a new procedure due to fallopian tube complications, particularly infections. Their frequency is given as up to 35%. In addition, removing the fallopian tubes at the same time means reducing the risk of malignant tumors in the fallopian tubes, ovaries and peritoneum, since the fallopian tubes are the starting point for some of these diseases. However, the risk reduction is only slight and the procedure may be associated with a deterioration in ovarian blood flow and thus a somewhat earlier menopause , so that the measure is controversial.

In the case of malignant diseases, squamous cell carcinoma of the cervix in young women does not require removal of the adnexa. However, if you have cancer of the lining of the womb (endometrial cancer) of the uterus, adenocarcinoma of the cervix and cancer of the ovaries, the ovaries and fallopian tubes must always be removed.

Anaesthesiological aspects

While regional anesthesia procedures such as spinal anesthesia can also be used with vaginal hysterectomy, general anesthesia is usually used for procedures with abdominal access . This is performed as intubation anesthesia , since a laryngeal mask does not provide adequate protection against the aspiration of gastric juice, especially in the case of laparoscopic procedures . Pronounced pre-existing cardiovascular diseases can limit the feasibility of a laparoscopy due to the side effects on cardiovascular and pulmonary function, so that an open access must be selected as an alternative. However, older women are less affected by such diseases than men. Patients with extensive previous vaginal bleeding may have acute anemia with low hemoglobin , which may require therapy with blood products .

Gynecological operations, especially hysterectomy, are associated with significantly higher rates of postoperative nausea and vomiting (PONV, in up to 80% of patients) compared to other operations . Whether the intervention is a specific cause for this is controversial, but based on the current data, it is rather rejected. The high incidence is probably mainly due to the risk profile of the patients, since the female gender factor per se is associated with a two to three-fold statistical rate of PONV. A large number of therapy options exist for the prophylaxis and treatment of postoperative nausea, such as performing a total intravenous anesthesia and administering various antiemetics ( dexamethasone , setrone, etc.).

The Wertheim-Meigs operation is a great engagement of the abdomen, if possible, in combination anesthesia (general anesthesia in combination with a thoracic epidural anesthesia is performed). The potentially large shifts and losses of fluid, as well as the often pre-existing anemia, make differentiated monitoring (possibly invasive blood pressure measurement , central venous catheterization ) and volume therapy and, if necessary, transfusion of blood reserves necessary. In patients without previous cardiac diseases, controlled hypotension can reduce blood loss. Post-operatively, care in a guard or intensive care unit is often necessary. Patients can be offered (peridural or intravenous ) patient-controlled pain therapy .

rehabilitation

After a hysterectomy for benign diseases, no explicit rehabilitation measures are usually necessary. Wound healing and regeneration takes place within approx. 3 weeks after the operation, which can be supported by physiotherapy. During this time, the patients should rest and relax. Full resilience of the body is restored on average after 4 weeks. Following a hysterectomy in the case of malignant diseases and other oncological therapy measures, a stay in a rehabilitation clinic is often useful. Physical after-effects of the illness are treated there and the patients are supported by psychological support.

consequences

A hysterectomy irrevocably ends a woman's childbearing ability. The menstrual period may, at the complete removal of the uterus no longer occur because the target organ, the endometrium , the cyclic hormonal changes no longer exists. In subtotal surgery without leaving the cervix, on the other hand, slight cyclical bleeding is not uncommon.

After a hysterectomy without adnexa, menopause can be expected slightly earlier, which seems to be due to a deteriorated blood supply to the ovaries.

However, recent studies have shown that patient satisfaction after hysterectomy is very high. The elimination of menstrual bleeding and the need for contraception are perceived by many women as an improvement in life. So far, there is no convincing evidence of any significant disturbances in psychological well-being or sexual perception. Individual reports of variously pronounced sexual changes, such as loss of uterine orgasm sensation , sometimes noticeable shortening and dryness of the vagina , and loss of libido have been reported. Some women also suffer significantly from the loss of their uterus. A central aspect here is the feeling of not being a “complete” woman anymore.

Overall, however, there is little evidence of deterioration, but rather numerous reports of improvement in sexual function from a hysterectomy. 85 percent of the patients in the Maryland Women's Health Study reported an increased frequency of sexual intercourse , less discomfort during intercourse ( dyspareunia ), more frequent orgasms , increased libido and less vaginal dryness 6, 12, 18 and 24 months after hysterectomy .

Complications

Typical rare complications and thus risks of hysterectomy are wound healing disorders, damage to the intestine, ureter or bladder , as well as (secondary) bleeding. In 2008, the German Federal Office for Quality Assurance found in 77,549 patients (without carcinoma , without endometriosis and without prior surgery in the same operating area) an organ injury in 724 patients (0.9 percent). Urinary tract infections are relatively common. In the medium term, women after a hysterectomy can experience pain, weakness, fatigue and exhaustion for weeks and months.

Incisional hernias , adhesions , subsidence of the vaginal stump and pain during sexual intercourse ( dyspareunia ) occur. Scientists at the Karolinska Institute in Sweden found in a study of over 165,000 women with and 480,000 women without a hysterectomy that removing the uterus increases the risk of urinary incontinence (bladder weakness). Twice as many women had to be treated for urinary incontinence after a hysterectomy as women with a uterus. Women who have had their uterus removed before menopause ("last regular menstrual period") or who have given birth to several children are particularly at risk . Vaginal hysterectomy was associated with the highest rate of subsequent resection operations. However, the reasons for this are unclear. Compared to complete removal of the uterus, preserving the cervix does not offer any protection against urinary incontinence that develops later, the connection of which with hysterectomy has even been fundamentally questioned in some studies.

The crushing ( morcellement ) of myomas and uteri can in very rare cases, regardless of the type of operation (abdominal incision, operation via the vagina or laparoscopy), also lead to the spread of benign, but also of initially unknown malignant tissue in the abdominal cavity.

Alternatives

Benign diseases

It has repeatedly been criticized that too many hysterectomies are performed, especially since hysterectomies are associated with risks and alternative treatment methods exist for many benign changes.

Menstrual disorders can hormonally treated. In many cases, there is also the option of endometrial ablation , i.e. an isolated thermal or hysteroscopic destruction of the uterine lining.

An endometriosis can, with the exception of adenomyosis, in which the endometrial implants are the uterine muscle, to be operated separately. Hormonal treatment is also promising.

Myomas in the uterine cavity, called submucosal myomas, can often be removed hysteroscopically . Myomas in the muscles (intramural myomas) or on the outside of the uterus (subserous myomas) can be operated on laparoscopically or with an abdominal incision while preserving the uterus. There is also the option of uterine fibroid embolization and targeted ultrasound heating of the fibroids. However, no histological examination is possible with either variant .

The Federal Office for Quality Assurance (BQS) recommends - especially for younger women - to first exhaust all conservative treatment options before performing a hysterectomy.

  • Removal of a single myoma by laparoscopy as an alternative to hysterectomy

  • Suture after removal of a fibroid by laparoscopy

  • Hysteroscopic view of a submucosal myoma of the posterior wall of the uterus

  • Endometriosis on the peritoneum between the bladder and uterus (removal possible while preserving the uterus)

  • Adenomyosis uteri (endometriosis of the uterine wall) (uterine preservation surgery is usually not possible)

Malignant diseases

In cervical cancer in stages III and IV or in inoperable patients, primary combined radiation therapy or simultaneous radiochemotherapy is possible. A endometrial cancer can at high surgical risk due to comorbidities or difficult operation conditions, such as severe obesity , are treated by combined radiotherapy. In ovarian cancer, chemotherapy alone cannot cure the disease, but it can inhibit the progression of the disease or reduce sequelae such as ascites . Radiation therapy is not indicated for ovarian cancer.

Statistics, regional differences

The partial or complete surgical removal of the uterus is one of the most common surgical interventions in gynecology and obstetrics, which is also performed to a comparatively high and regionally different proportion by hospital departments. While there was a significant reduction in hysterectomies (OPS code 5-683) in Germany from approx. 138,000 to approx. 125,000 between 2007 and 2009, the number of subtotal uterine extirpations (OPS code 5-682) increased in the same period from approx. 9,000 to approx. 14,000 clearly.

There are clear differences across Germany in the frequency of operations in the individual districts. In the district with the highest OP index (actual number of operations / expected number of operations) of 1.7, this is more than three times higher than in the circle with the lowest index (0.5). If the 20 districts with the highest and the 20 districts with the lowest OP index are not included in the analysis, the OP index for the remaining districts is only about twice as wide (0.8 to 1, 4). The frequency of operations among women who live in the (larger) cities is rather average or below average.

The regional differences in the frequency of performing hysterectomies and the indications for hysterectomies have been discussed in various countries for many decades, because studies have shown that a considerable number of hysterectomies are performed without adequate indications. The currently still existing variations indicate that the indication for hysterectomy is apparently still more generous in some regions than in others. At the professional level, there is increasing discussion about which indications for hysterectomy are undisputed and for which indications patients and / or doctors have the freedom to make decisions that make it possible to avoid hysterectomy.

The decreasing total number of hysterectomies could be an indication that the indication has been increasingly critical in recent years. However, in the treatment of the uterus myomatosus, for example, new and above all conservative methods are not used to a sufficient extent. It can therefore be important to what extent the individual treating hospitals and doctors have access to all diagnostic options that are relevant for the decision, and the speed at which knowledge about new treatment methods is generally disseminated and applied. This also affects the treating resident gynecologists, who influence the decision to which hospital the patients should turn to for further care. Such differences can explain the regional variations in the frequency of hysterectomy.

In 2013, a study by the Robert Koch Institute , which is part of health monitoring, showed that there is a very clear connection between the social status of the patient and a hysterectomy. Of the 8,152 women who took part in the study, women with low social status were twice as likely to have a hysterectomy as those with a higher level of education. On the one hand, this is attributed to the fact that better educated people generally have better health on average ; they are less exposed to stress , they operate better health care and are more likely to take measures for the early detection of diseases . On the other hand, the doctors are more willing to offer and explain treatment methods to these patients that can avoid the removal of the uterus.

Legal

Also for the removal of the uterus is required, as well as for all other operations, in addition to a medical indication , of course, the consent of the patient. As part of the medical education , possible alternatives as well as advantages and disadvantages of the surgical methods should be explained to the patient.

In principle, it is possible to take egg cells from a patient who wishes to have children as part of a hysterectomy and to freeze them for later fertilization or to obtain them for in vitro fertilization after a uterus has been removed . The resulting embryos can only be carried by a surrogate mother . However, this is not allowed in many countries. In Germany, for example, the Embryo Protection Act prohibits surrogacy.

history

First attempts to remove the uterus could be traced back to the 1st century in the time of Soranos of Ephesus , at that time for the treatment of an infected uterus in the case of a subsidence. Until the 18th century, a hysterectomy was usually not survivable. At the beginning of the 19th century there were again proven attempts to remove the uterus. One of the first hysterectomies happened in 1812, when Giovanni Battista Palletta in Milan wanted to remove a cervix for a cervical cancer and performed a total hysterectomy, which the patient only survived two days.

The first complete vaginal hysterectomies for cancer of the uterus were performed by Friedrich Benjamin Osiander in 1801 , Konrad Johann Martin Langenbeck in 1813 and Johann Nepomuk Sauter in 1822 . In November 1843, Charles Clay performed a supracervical hysterectomy in Manchester . However, it was only after James Young Simpson introduced chloroform for anesthesia in 1847 that major advances were possible in surgery and thus also in surgical gynecology .

Walter Burnham ( Lowell , Massachusetts) unplannedly removed a uterus through an abdominal incision in June 1853. The first successful complete abdominal hysterectomy in 1853 is associated with the name Gilman Kimball (1804-1892, also Lowell, Massachusetts). On January 2, 1861, a first vaginal hysterectomy without injury to the bladder and rectum was performed by S. Choppin in New Orleans , which was not repeated until 1876 by A. Petterson in Glasgow.

The first successful removal of the uterus and ovaries was achieved in 1863 by the anatomist and gynecologist Eugène Koeberlé (1828–1915), who worked at the Clinique de la Toussaint in Strasbourg until 1880 .

In the second half of the 19th century, hysterectomy was sometimes used to treat hysteria . It was assumed that hysteria was a typically feminine trait and was related to the uterus, an idea that can be traced back to antiquity. (see also History of Women's Suffering )

In 1878 Wilhelm Alexander Freund performed the first repeatable complete removal of the uterus via an abdominal incision in a patient with cervical cancer in Breslau . Other doctors refined the methods and developed them further.

On August 12, 1879, the surgeon Vincenz Czerny performed a hysterectomy over the vagina in Heidelberg , which he was able to describe systematically for the first time. Since the results (with a recurrence rate of over 90%) were better than those of Freund's surgery, vaginal surgery was preferred in the years that followed. (For example, from 1884 by O. Thelen at the St. Josephs Hospital in Elberfeld).

Until about 1950, therefore, subtotal or vaginal removal was preferred for benign diseases. Since the introduction of antimicrobial substances, complete abdominal removal, in addition to the vaginal route, has gained acceptance because the risk of cervical cancer on the otherwise remaining cervix (cervix) could be reduced by early cancer detection.

Karl August Schuchardt succeeded in 1893 in Stettin with the first extended vaginal uterus removal for cervical cancer, which was further developed in 1901 by the Viennese gynecologist Friedrich Schauta , later by Walter Stoeckel at the Charité in Berlin and Isidor Alfred Amreich in Vienna. The Austrian gynecologist Ernst Wertheim developed a radical surgical method using an abdominal incision in 1898 , which the American Joe Vincent Meigs later developed.

Following preliminary work by Kurt Semm , Harry Reich performed the first laparoscopic hysterectomy in Pennsylvania in 1988 . In the 1980s, several variants of partial hysterectomy were developed. In 1991, Semm described a laparoscopic subtotal hysterectomy. He called his version CISH (Classic Intrafascial Semm Hysterectomy) and combined the grinding (morcellement) of the uterus with peeling off the cervix. However, the method never received any further recognition. Jacques Donnez ( Belgium ) published the laparoscopic supracervical hysterectomy in 1993, which is now widely used in this form.

Since the 1990s, the introduction of new surgical techniques, such as the laparoscopic Wertheim operation, trachelectomy or total mesometrial resection of the uterus and the possibility of removing lymph nodes by means of laparoscopy , led to an incipient individualization of surgical therapy for malignant diseases, sometimes consciously reduced, partially improved completeness (radicality) of surgical carcinoma removal .

literature

Web links

Wiktionary: hysterectomy  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ^ Wilhelm Gemoll : Greek-German school and hand dictionary . G. Freytag Verlag / Hölder-Pichler-Tempsky, Munich / Vienna 1965.
  2. ↑ a b c Gunhild Buse: - As if I had lost a treasure chest: Hysterectomy from the perspective of feminist-theological medical ethics . LIT Verlag, Berlin / Hamburg / Münster 2003, ISBN 3-8258-6037-X ( limited preview in the Google book search).
  3. ↑ a b Gisela Lösche: The meaningfulness of the term “total operation”. (1984) In: Paul R. Franke, Matthias David (Ed.): The other way to the same goal - Psychosomatic gynecology. Selected contributions to the symposia of the East German Society for Psychosomatic Gynecology and Obstetrics 1984–1994. akademos Wissenschaftsverlag, Hamburg / Berlin 2002, ISBN 3-934410-34-0 .
  4. ↑ DT Rein, T. Schmidt, M. Fleisch, R. Wagner, W. Janni: Multimodale treatment of the uterus myomatosus. In: Gynecologist. 50, 2009, pp. 752-758. Frauenarzt.de ( Memento from March 31, 2010 in the Internet Archive ) (PDF; 520 kB)
  5. ↑ a b c A. Taran, G. Gaffke, M. Rüsch, H. Heuer, B. Hosang, J. Ricke, S.-D. Costa : The modern multimodal therapy of the uterus myomatosus: when is a hysterectomy indicated? In: Ärzteblatt Sachsen-Anhalt. 19, 2008, pp. 38-45. aerzteblatt-sachsen-anhalt.de ( Memento from January 26, 2009 in the Internet Archive ) (PDF; 375 kB)
  6. ^ A b F. Prütz, H. Knopf, E. von der Lippe, C. Scheidt-Nave, A. Starker, J. Fuchs: Prevalence of hysterectomies in women aged 18 to 79 years. In: Federal Health Gazette . 2013, No. 5–6, pp. 716–722. doi: 10.1007 / s00103-012-1660-7 . Retrieved October 2, 2013.
  7. ↑ a b M. Thill, A. Hornemann, D. Fischer, K. Diedrich, C. Altgassen: Vaginale and abdominal hysterectomy. In: Gynecologist. 41, 2008, pp. 328-336. doi: 10.1007 / s00129-008-2130-z
  8. ↑ C. Yaman, J. Reist, F. Wutzlhofer, G. Tews: Gas fire in the puerperium. In: obstetric women's health. 60, 2000, pp. 169-171. doi: 10.1055 / s-2000-5916
  9. ↑ P. Husslein: Postpartum bleeding. In: Gynecologist. 30, 1997, pp. 769-774. doi: 10.1007 / s001290050181
  10. ↑ Christina A. Rossi, Richard H. Lee, Ramen H. Chmait: Emergency Postpartum Hysterectomy for Uncontrolled Postpartum Bleeding: A Systematic Review. In: Obstet Gynecol . 115, 2010, pp. 637-644. PMID 20177297 . doi: 10.1097 / AOG.0b013e3181cfc007
  11. ↑ Decision - 1 BvR 3295/07 - of the BVerfG of January 11, 2011
  12. ↑ JD Wright, CV Ananth, SN Lewin et al. a .: Robotically Assisted vs Laparoscopic Hysterectomy Among Women With Benign Gynecologic Disease. In: JAMA. 309 (7), 2013, pp. 689-698. doi: 10.1001 / jama.2013.186
  13. ↑ a b c d D. Dian, B. Rack, C. Schindlbeck, W. Janni, K. Friese: Endoscopic Hysterectomy. LAVH, LASH, TLH and NOTE-AVH. In: Gynecologist. 41, 2008, pp. 343-348. doi: 10.1007 / s00129-008-2134-8
  14. ↑ B. Uhl, D. Thiemann-Janßen: Minimally invasive surgical method for extremely large uteri: vaginal-assisted laparoscopic hysterectomy. In: Gyn. 13, 2008, pp. 154-156.
  15. ↑ a b c Guideline on laparoscopic supracervical hysterectomy (LASH) of the German Society for Gynecology and Obstetrics , Working Group Gynecological Endoscopy (AGE). In: AWMF online (as of 11/2009)
  16. ↑ D. Rein, T. Schmidt: Laparoscopic supracervical hysterectomy (LASH). In: Gynecologist. 38, 2005, pp. 959-967. doi: 10.1007 / s00129-005-1763-4
  17. ^ A. Salfelder, RP Lueken, C. Bormann, A. Gallinat, CP Moeller, D. Busche, W. Nugent, E. Krueger, A. Nugent, V. Scotland: The supracervical hysterectomy in a new light. Rediscovery as a minimally invasive method. In: Gynecologist. 44, 2003, pp. 1071-1975. Frauenarzt.de ( Memento from March 4, 2016 in the Internet Archive ) (PDF; 118 kB)
  18. ↑ Christine Wolfrum: Rash cuts. In: pharmacies look around . June 1, 2008. Wort & Bild Verlag , Baierbrunn.
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