A hysterectomy is a common surgical procedure involving the removal of the uterus, an organ central to the female reproductive system. The procedure is often recommended to treat conditions like uterine fibroids, severe endometriosis, or abnormal uterine bleeding when other treatments have not provided relief. The classification of the hysterectomy depends entirely on which parts of the reproductive tract are removed. The term “partial” refers to a specific surgical approach that preserves one particular organ.
The Specifics of a Partial Hysterectomy
A partial hysterectomy is defined by the fact that the main body of the uterus is removed while the cervix remains intact. The cervix is the lower, narrow part of the uterus that connects to the vagina. This procedure is also known by the more specific medical terms, subtotal hysterectomy or supracervical hysterectomy, which more accurately describe the surgical plane.
In a supracervical hysterectomy, the surgeon cuts across the upper portion of the uterus, leaving the entire cervix and its supportive ligaments in place. This approach may be chosen for a shorter operating time and faster recovery. Leaving the cervix intact was historically thought to provide better structural support for the pelvic organs, though recent evidence suggests this benefit may be minimal.
The decision to retain the cervix is typically made when there is no history of cervical disease. Patients who have this procedure must continue to receive regular cervical cancer screenings, including Pap tests, because the tissue that can develop cancer is still present. Furthermore, some patients may experience a light, period-like bleeding, known as cyclic bleeding, because a small amount of endometrial tissue can remain in the cervical stump.
Contrasting Partial and Total Hysterectomy
The difference between a partial and a total hysterectomy is the removal of the cervix. A total hysterectomy involves the removal of the entire uterus, including both the main upper portion and the cervix. This distinction, based solely on the fate of the cervix, is the defining factor in classifying the two most common types of hysterectomy.
When a total hysterectomy is performed, the cervix is removed, and the top of the vagina is then surgically closed to form a vaginal cuff. This approach is often necessary if the patient has a history of cervical dysplasia or is at an elevated risk for cervical cancer. The removal of the cervix eliminates the risk of future cervical cancer and the need for subsequent Pap smear screenings.
The choice between the two procedures is made after considering the patient’s medical history, the underlying condition requiring the hysterectomy, and the patient’s individual preferences. While the surgical risks and long-term outcomes, such as effects on sexual function, appear similar between the two procedures, the decision hinges on the presence of or risk for cervical pathology.
Concurrent Procedures Involving Ovaries and Fallopian Tubes
Patient confusion often arises because the removal of the ovaries and fallopian tubes is a surgical decision separate from the classification of the hysterectomy as partial or total. The removal of these organs, collectively known as the adnexa, can be performed concurrently with either type of hysterectomy. These secondary procedures have their own distinct names and rationales.
The surgical removal of the fallopian tubes is called a salpingectomy, while the removal of the ovaries is known as an oophorectomy. When both the fallopian tube and the ovary on one side are removed together, the procedure is termed a salpingo-oophorectomy. It is possible to have a partial hysterectomy, where the cervix is left, and simultaneously have a salpingo-oophorectomy performed.
A growing practice is the removal of the fallopian tubes, or opportunistic salpingectomy, even when the ovaries are retained, as a preventative measure. This is based on evidence suggesting that many ovarian cancers may actually originate in the fallopian tubes. This separate procedure can significantly reduce the risk of developing ovarian cancer in the future.
If the ovaries are removed, either unilaterally or bilaterally, the patient will immediately enter surgical menopause, regardless of whether a partial or total hysterectomy was performed. The ovaries are the main source of estrogen, and their removal causes an abrupt cessation of hormone production. Conversely, if the ovaries are retained, they will continue to produce hormones, preventing immediate surgical menopause and its associated symptoms.
When a total hysterectomy is performed, the cervix is removed, and the top of the vagina is then surgically closed to form a vaginal cuff. This approach is often necessary if the patient has a history of cervical dysplasia, which is abnormal cell growth, or is at an elevated risk for cervical cancer. The removal of the cervix eliminates the risk of future cervical cancer and the need for subsequent Pap smear screenings related to the cervix.
In cases where the cervix is retained, the patient must understand that they are still at risk for cervical disease and must continue with preventative screenings. The choice between the two procedures is made after considering the patient’s medical history, the underlying condition requiring the hysterectomy, and the patient’s individual preferences. While the surgical risks and long-term outcomes, such as effects on sexual function, appear similar between the two procedures, the decision hinges on the presence of or risk for cervical pathology.
Concurrent Procedures Involving Ovaries and Fallopian Tubes
Patient confusion often arises because the removal of the ovaries and fallopian tubes is a surgical decision separate from the classification of the hysterectomy as partial or total. The removal of these organs, collectively known as the adnexa, can be performed concurrently with either type of hysterectomy. These secondary procedures have their own distinct names and rationales.
The surgical removal of the fallopian tubes is called a salpingectomy, while the removal of the ovaries is known as an oophorectomy. When both the fallopian tube and the ovary on one side are removed together, the procedure is termed a salpingo-oophorectomy. It is possible to have a partial hysterectomy, where the cervix is left, and simultaneously have a salpingo-oophorectomy performed.
A growing practice is the removal of the fallopian tubes, or opportunistic salpingectomy, even when the ovaries are retained, as a preventative measure. This is based on evidence suggesting that many ovarian cancers may actually originate in the fallopian tubes. This separate procedure can significantly reduce the risk of developing ovarian cancer in the future.
If the ovaries are removed, either unilaterally or bilaterally, the patient will immediately enter surgical menopause, regardless of whether a partial or total hysterectomy was performed. The ovaries are the main source of estrogen, and their removal causes an abrupt cessation of hormone production. Conversely, if the ovaries are retained, they will continue to produce hormones, preventing immediate surgical menopause and its associated symptoms.