Total surgery

Total surgery is a term without a clear meaning , which is used mainly by medical laypersons in connection with the removal of the uterus ( hysterectomy ). Different ideas about the extent of the operation are associated with the use of the term. Doctors also use the term in an effort to make themselves understandable to patients. However, the term is also used in various contexts for medical information, which, on the one hand, maintains its continued use among laypeople and, on the other hand, makes it difficult to understand.

A clear definition of the term total operation is made more difficult by the fact that doctors from other specialties use it for completely different operations, for example urologists for the complete removal of the prostate gland, for example for prostate cancer, and surgeons for certain thyroid or stomach operations .

Technical terms and their meaning

The complete surgical removal of an organ is technically correctly referred to as total extirpation or ectomy . The correct terms for a complete removal of the uterus are therefore hysterectomy or total uterine extirpation and distinguish this from subtotal uterine extirpation , i.e. the incomplete removal of the uterus in which the cervix is preserved.
In either case, the operation does not include the removal of the ovaries and fallopian tubes ( adnexa ) . The removal of the adnexa is called a unilateral or bilateral adnexectomy , regardless of whether it is performed in addition to a hysterectomy or as a separate procedure.

history

Up until the 1990s, there were three standard uterine removal techniques:

• The complete removal of the uterus through the vagina
• The complete removal of the uterus with cervix through the abdomen ( abdomen )
• The incomplete removal of the uterus without a cervix through the abdomen

Incomplete removal through the abdomen ( subtotal abdominal uterine extirpation ) was, until the first half of the 20th century, under the not yet so advanced operating conditions, much easier and quicker to carry out than complete removal through the abdomen ( total abdominal uterine extirpation ) and therefore became much more common executed. It also had the advantage of lower risk of wound infection , in particular of peritonitis , which is almost always fatal , since the cervix was retained as a barrier between the vagina and the abdominal cavity. Far fewer women died after a subtotal uterine extirpation than after a (complete) hysterectomy . This was offset by the disadvantage that cervical cancer could continue to develop. The technique of incomplete hysterectomy has been superseded by full hysterectomy since the 1950s as the operating conditions ( anesthesia , antisepsis, etc.) improved . Since around 1995 this has been changing again in favor of incomplete uterine removal, because new techniques have been developed for this in recent years and the risk of developing cervical cancer has decreased for various reasons.

Conceptual confusion in linguistic usage

Especially now older women were operated on at a time when the term total (abdominal) uterine extirpation , abbreviated also TE or total, was still part of everyday medical usage. In this context, you speak of the fact that you have been "fully operated" , that it is "all out" . They usually have the idea that the uterus and ovaries have been removed. Often this was also the case because until the 1990s there was no consensus among surgeons as to whether or not the ovaries of women who had passed the age of 40 should also be removed during a hysterectomy to prevent ovarian cancer.
However, this notion is not always correct. During repeated operations, it is often found that the ovaries are still present despite an alleged total operation .

The use of the term has not been standardized in recent years. In addition to the above-mentioned operations in other medical disciplines, various invasive (interventional) forms of uterine removal are currently referred to as total surgery :

• only the removal of the entire uterus, quote: "In the case of very large, unfavorably located or particularly numerous fibroids , the doctor recommends removing the uterus (total operation, hysterectomy), especially if the family planning has already been completed."
• the removal of the uterus and ovaries, quote: "... the removal of the uterus and ovaries - often referred to by women and gynecologists as" total surgery "..."
• the extended (“radical”) removal of the uterus with removal of the ovaries and lymph nodes (operation of certain stages of ovarian cancer), quote: "... if the risk is high, the entire uterus, both ovaries and the pelvic lymph nodes may be removed so-called Wertheim-Meigs operation known as "total operation". "

The term total operation was criticized among other things

• 1984 from Lösche
• 2001/2002 by Gunhild Buse

Individual evidence

1. ↑ Urology, Essen-Mitte Clinics, s. Section "Malignant Neoplasm of the Prostate"
2. ↑ Press release from the Asklepios Clinic Hamburg-Barmbek
3. ↑ ^{a b} A. Hirsch, O. Käser, FA Iklé: Atlas of gynecological operations 5th edition. Thieme Verlag, Stuttgart 1995.
4. ↑ Recommendation of the German Society for Gynecology and Obstetrics (PDF)
5. ↑ Health today, medically supervised information portal ( memento of the original from November 3, 2010 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
6. ^ Kai Joachim Bühling, Wolfgang Friedmann: Intensive course in gynecology and obstetrics. Urban & Fischer, 2003, p. 60.
7. ↑ Patient information page of the Bremen Center Clinic (PDF, p. 3)  ( page can no longer be accessed , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.  
8. ↑ H. Lösche: The meaningfulness of the term “total operation”. 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. 1984, ISBN 3-934410-34-0 [1]
9. ↑ 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 , pp. 172 and 173 .