I. Indications—surgical removal of the uterus
a. Malignancies: 11% of hysterectomies
b. Nonmalignant conditions, such as endometriosis, fibroid
tumors; pelvic relaxation with uterine prolapse that leads
to disabling levels of pain, discomfort, uterine bleeding,
c. Life-threatening bleeding or hemorrhaging, such as
obstetric or traumatic complication; irreparable rupture of
d. Treatment of intractable pelvic infection
a. Abdominal hysterectomy
i. Subtotal or partial: removal of body of uterus; cervical
ii. Total: removal of the uterus and cervix
iii. Total with bilateral salpingo-oophorectomy: removal of
uterus, cervix, fallopian tubes, and ovaries
iv. Total pelvic exenteration (TPE): Complex, aggressive
surgical procedure involving radical hysterectomy
with dissection of pelvic lymph nodes, bilateral
salpingo-oophorectomy, total cystectomy, and
abdominoperineal resection of the rectum; colostomy
and/or urinary conduit are created, and vaginal
reconstruction may or may not be performed. (Refer to
additional care plans regarding fecal or urinary
diversions, as appropriate.)
b. Vaginal hysterectomy or laparoscopically assisted vaginal
i. Limited to certain conditions, such as uterine prolapse,
cystocele or rectocele, carcinoma in situ, and high-risk
ii. Requires removal of cervix
iii. Advantages: less pain, no visible (or much smaller)
scars, shorter hospital stay, and shorter recovery period
of about 3 to 4 weeks (vaginal) and 2 weeks (LAVH)
versus approximately 6 weeks (abdominal)
iv. Research suggests laparoscopic procedure is associated
with a higher rate of complications than abdominal
c. Laparoscopic supracervical hysterectomy (LSH)
i. Can be performed in presence of mild to moderate
adhesions or large uterus
ii. Three or four small abdominal incisions with
uterus removed in small pieces through a tube in the
iii. Removal of cervix not required
iv. Usually done on outpatient basis, with a recovery
period of about 1 week
III. Statistics (Gor et al, 2006; National Uterine Fibroids
a. Morbidity: 600,000 are performed annually; 37% of all
women undergo hysterectomy by age 60 in the United States.
b. Mortality: Approximately 660 women die annually.
c. Cost: $5 billion annually in the United States
Procedure is performed in inpatient acute surgical unit or
short-stay unit or outpatient, depending on type performed.
Psychosocial aspects of care
Surgical intervention(for general considerations
Thrombophlebitis: deep vein thrombosis
1. Support adaptation to change.
2. Prevent complications.
3. Provide information about procedure, prognosis, and treatment
1. Dealing realistically with situation.
2. Complications prevented or minimized.
3. Procedure, prognosis, and therapeutic regimen understood.
4. Plan in place to meet needs after discharge.