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Scott Webb (Host): Though hysterectomies are considered major surgery, they are common, and outcomes in patient satisfaction generally outweigh potential risks for most patients. And joining me today to tell us more is Dr. Bethany Conly. She's an OB-GYN with Salinas Valley Health.

This is Ask the Experts, the podcast from Salinas Valley Health. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about hysterectomies and everything involved, so it's great to have your expertise. As we get rolling here, the baseline question, what is a hysterectomy?

Dr. Bethany Conly: Essentially, the word hysterectomy comes from hyster- and -ectomy. So, hyster- means uterus; -ectomy means surgical removal. So, hysterectomy, surgical procedure to remove the uterus and the cervix. And the uterus is basically the organ that creates a woman's menstrual period and also can grow a baby during pregnancy. The cervix is a muscular opening of the uterus, which separates the uterus from the vagina. It's generally done for women who are having issues with bleeding, fibroids, which are kind of these balls of muscles that can grow on the uterus, or other gynecologic issues such as cancers or pre-cancers.

Host: Yeah. And pardon my ignorance, doctor, but are there different types of hysterectomies? You know, is there a variety, like there's a hysterectomy A and B, and C and D? Or is it if you're doing a hysterectomy, then it kind of covers everything?

Dr. Bethany Conly: Yeah, great question. So definitely true, there's a lot of different words that are thrown around for hysterectomies. And the same thing said by one person might not mean the same thing for someone else. So, a lot of times it's a lot of clarifying for people. But essentially, it usually means removing the uterus and the cervix. It often can remove ovaries or fallopian tubes depending on the situation. But ultimately, you know, the main types are going to be either a total hysterectomy, which generally as a gynecologist would refer to it means removal of the cervix and the uterus. The supracervical hysterectomy is less common, but can also be done, and that's where essentially the uterus is removed, but not the cervix.

Host: So doctor, it seems like this is a big change, right? For women, perhaps for their families, partners and so on, but especially for them and their bodies. Maybe you can talk about that. What happens to a woman's body after they undergo a hysterectomy, whatever, you know, full, partial or otherwise?

Dr. Bethany Conly: You know, there's kind of the difference between the immediate changes. So, an immediate change is going to be for someone who's having issues with bloating or pain or bleeding issues, immediately those things are usually improved, which is nice, but you're also then dealing with the surgical recovery. And so, that is generally about an eight-week total recovery. During which time, mainly the top of the vagina where the uterus and cervix are removed has to take extra time to heal because it's vulnerable to issues like infection or stitches not healing correctly. And so during that eight-week period, women are going to have some discomfort. They're going to need to limit how much they're lifting and bending, so that that allows full healing. The immediate couple weeks after surgery, especially the first two to three weeks, is when most people have more discomfort near like the skin incisions where the instruments are used to actually do the surgery, but that usually improves within a couple of weeks. Bleeding, usually, like I said, stops. But some women will have a little bit of spotting or discharge from the vagina during that healing period as everything's kind of going to its new normal.

Host: Sure. Yeah, new normal for sure. And I'm assuming that the hysterectomies are done laparoscopically, perhaps robotically. Maybe you can tell us about the surgery, how long it lasts. Is this considered, you know, major surgery?

Dr. Bethany Conly: So yeah, definitely considered a major surgery. However, it's also a very common surgery. It is generally done laparoscopically these days, although there are some nuances to that. So if, for instance, someone has a small uterus and no concerns for significant scar tissue or other things from previous surgeries, then they may be a candidate for something called a vaginal hysterectomy, and that's actually where the entire procedure is performed through the vagina without any incisions on the belly.

Now, probably the most common is a laparoscopic hysterectomy, and that's done through small incisions on the belly, usually three to four, less than one centimeter incisions. And we use small instruments to actually remove the uterus from its attachments and then remove it either through the vagina or a slightly larger incision through the belly. Then, robotic, it's also true that's considered kind of a form of laparoscopy, but it's used as an actual robot. So now, the robot doesn't do the surgery. The surgeon's doing it, but they're operating the robot remotely, essentially. Some hospitals have that available and some don't. And sometimes that's better surgery for people, and sometimes it's not. It kind of depends on the situation. And someone who's getting into, you know, possibly having a hysterectomy, I would just recommend having that discussion with your surgeon.

And then, finally, there's the abdominal hysterectomy, and that's actually where we make an incision similar usually to a cesarean section. And that is done usually for very large uteruses or people who have other factors that might make a laparoscopic surgery either impossible or risky. A larger incision means a little more pain during the recovery and a little more of a recovery, especially in the first couple of weeks. But ultimately, the overall recovery for any form of hysterectomy is going to be about eight weeks.

Host: Yeah, I'm wondering because it is major surgery and everything that that might imply, even in the hands of an expert, an expert surgeon, do women-- are they able to go home, maybe not that day, but at least the next day?

Dr. Bethany Conly: It depends a lot on the factors. But in general, if you have a minimally invasive form of hysterectomy, so that would be either vaginal, laparoscopic or robotic. It's kind of your option. You can go home the same day, although many women will stay overnight and go home the next day, just because they feel more comfortable, you know, being observed overnight. And then, if you have an abdominal hysterectomy, which is also called an open hysterectomy, in that situation, then with a larger incision, we usually have people stay for one to two days after surgery. That's just because with the larger incision, it can be a little bit harder for the bowels to start working again. And so, we want to make sure that we're seeing that return of function before someone goes home.

Host: Yeah. Is there anybody who's not an ideal or at least a good candidate for a hysterectomy?

Dr. Bethany Conly: Yeah, definitely a good question. I'd say in general, if someone really needs a hysterectomy because they're having severe bleeding issues, getting anemic or just have a really large bothersome uterus, most women are ultimately going to be a candidate for this surgery. However, if there's conservative treatments available to somebody, you know, whether that's medications, an IUD, something called an ablation, other smaller procedures. If someone has a lot of comorbidities such as, you know, severe heart disease, stroke, something that would make surgery a big risk for them, then in that case, it may be that the benefits of this surgery would be outweighed by the risks and the more conservative treatment might make more sense for that patient.

Host: Yeah. And you talked about the recovery time, about eight weeks or so generally for the new normal. Are there any side effects associated with a hysterectomy?

Dr. Bethany Conly: Yeah, I mean there's definitely like risks to the surgery and, you know, as any good surgeon will tell you, there's always going to be risks, even if they're very small. And that'll include, you know, for hysterectomy, the main ones are going to be bleeding, possibility of infection or injury to organs such as the bowel or bladder.

And as far as kind of other side effects that maybe people might not think about as much, there's a risk of blood clots with any surgery, that would be like blood clots that form in the veins of the legs. And, you know, that could be very dangerous if it goes to the lungs. So, we always try to get people up and moving after surgery and we use little massage squeezers that go on the patient's legs during surgery to decrease that risk.

Other things that can potentially happen is that women can have issues with incontinence. And so, sometimes a uterus, which helps support the bladder and some of the pelvic floor muscles, sometimes when that uterus is removed, it can uncover an underlying issue such as urinary incontinence. But usually, that's also present prior to the surgery, it might just kind of unmask it a little bit more.

Host: I see what you mean. Sure. I just want to give you a chance here at the end. Final thoughts, takeaways, either women who have been thinking they would want this or need this or have been sort of dragging their feet a little bit, what would be your sort of words of encouragement.

Dr. Bethany Conly: Obviously, I'm a surgeon and I like to do surgery and happy to help people with that, but I always recommend talking to your doctor about options that don't include major surgery first, so that you can avoid that if you don't need it. But at the same time, I will say that the vast majority of my patients who choose to undergo a hysterectomy are so thankful that they did. And the most common refrain I hear at their post-op visits is, "Why didn't I do this sooner?"

Host: Absolutely. Well, doctor, thanks so much for your time today. You stay well.

Dr. Bethany Conly: Wonderful. Thank you as well.

Host: And for a full list of all of our podcasts, go to salinasvalleyhealth.com/podcasts.

And if you found this podcast to be helpful, please be sure to tell a friend, neighbor, or family member and subscribe, rate, and review this podcast and check out the entire podcast library for additional topics of interest. This is Ask the Experts from Salinas Valley Health. I'm Scott Webb. Stay well, and we'll talk again next time.