Hysterectomy is the second most common surgery performed on reproductive-aged American women. The procedure is highly invasive. In addition to removing the uterus as intended, physicians sometimes accidentally cause bowel and bladder damage or other unintended injuries. Hysterectomy remains controversial because doctors use it as a go-to treatment for chronic gynecological conditions. Even medical professionals debate the necessity of performing this procedure so frequently.
Like other major surgeries, when a physician uses sharp instruments inside the human body, there’s an inherent risk of unintended damage. Anesthesia also comes with risks. Surgery can also lead to infection, plus a long list of minor and major medical conditions and unintended injuries.
Doctors Perform Four Types of Hysterectomies
Depending on the reason for the surgery, doctors perform four different types of hysterectomies:
- Partial Hysterectomy: Uterus removal
- Total Hysterectomy: Uterus and cervix
- Hysterectomy with Bilateral Salpingo-Oophorectomy: Uterus, cervix, and fallopian tubes
- Radical Hysterectomy: Uterus, cervix, ovaries, fallopian tubes, and sometimes portions of the vagina and lymph nodes
All four of these procedures expose the patient to potential bowel and bladder injuries and other unintended injuries.
Why Do Doctors Perform So Many Hysterectomies?
Hysterectomy eliminates a woman’s ability to have children. Despite this drastic result, the numbers confirm how frequently American doctors have performed the surgery. One study, Nationwide Trends in the Performance of Inpatient Hysterectomy in the United States, documented 7,438,452 inpatient hysterectomies over 12 years. Women’s groups and medical professionals consider them often unnecessary because of alternative treatments.
Historically, doctors have used hysterectomy to solve many gynecological conditions. They recommend the surgery and perform it most often when a patient has fibroids/leiomyomas. Doctors sometimes treat this non-cancerous condition with a less-invasive treatment option, such as embolization. If a doctor doesn’t inform patients about less-invasive procedures, they can’t select that option.
Over the years, doctors have reduced the number of hysterectomies they perform.
However, they still recommend the surgery for:
- Fibroids/Leiomyomas
- Endometriosis
- Uterine prolapse/incontinence
- Uterine, cervical, and ovarian cancers
- Irregular bleeding
- Chronic pelvic pain
“Hysterectomy Practices and Patterns,” on the Journal of American Medical Association’s site JAMAnetwork.com, discusses a review of 75,487 abdominal hysterectomy patients. They found that the most frequent diagnoses cited for surgery included fibroids (33.9 percent), irregular bleeding (24.6 percent), and uterine prolapse/incontinence (15.8 percent).
Types of Hysterectomy Procedures
Doctors use several procedures when performing hysterectomies:
- Abdominal: Doctors access organs by making a 6 to 12 inch vertical or horizontal incision through the abdomen. This procedure usually requires a hospital stay and a longer healing time. It also causes complications more frequently, including bowel and bladder injury, infection, excessive scarring, improper healing, and other problems.
- Vaginal: Doctors remove a woman’s uterus through the vagina. This eliminates the need for abdominal incisions, making it a safer option. Vaginal hysterectomies often cost less and cause fewer complications than an open abdominal procedure. Although the risk is small, physicians have occasionally shortened and/or damaged patients’ vaginas during this type of operation.
- Laparoscopic Vaginal: A laparoscope is a surgical tool that includes a small camera for visibility during surgery. Doctors create two incisions to accommodate surgical tools. They insert the laparoscope into a third incision in the navel. For easier tissue removal, doctors break up the uterus using a power morcellator. When treating a benign condition, this process allows faster healing and fewer complications. Some patients sustain bladder injuries during the procedure. Afterward, they sometimes deal with urinary tract infections and other medical issues. Morcellator complications have triggered a reduction in laparoscopic uterine removal procedures.
- Laparoscopic-Assisted Abdominal: When using this lower-risk abdominal surgery approach, a physician requires only a single small abdominal incision. Doctors use this procedure when leaving the cervix intact.
- Robotic-Assisted Laparoscopic Hysterectomy: A doctor creates three incisions, one for the laparoscope and two for surgical tools. The doctor performs the surgery using a remotely controlled robot. Robotic surgery leaves a smaller scar but potential complications are the same as with hands-on laparoscopic surgery.
Hysterectomy complications
Like other major surgeries, patients sometimes deal with complications and unintended injuries during and after their hysterectomy.
Adverse conditions occur more frequently during open abdominal procedures, such as:
- Accidental puncture or laceration
- Bladder, bowel, and urinary tract dysfunction
- Dissemination of malignant tissue beyond the uterus
- Reaction to anesthesia
- Hemorrhage
- Infection
- Embolism
- Pneumonia
- Surgical site infection
- Renal failure
- Urinary tract infection
- Sexual dysfunction
Laparoscopic surgery causes fewer surgical complications than abdominal surgery.
However, here's why doctors don’t always use this surgery:
- Learning curve: A JAMA Network article, Learning Curves and the Challenges of Adopting New Surgical Techniques, explains how some physicians don’t use laparoscopic surgery as they haven’t mastered the technique. The article discusses low rates in laparoscopic colectomies, nephrectomies, and hysterectomies.
- Laparoscopic Power Morcellator Complications: Doctors use power morcellators to break up assumed benign tumors and tissues for removal. If the tissue is malignant, the process sometimes spreads malignant tissues beyond the surgical area. In 2020, the Food and Drug Administration released a new Guidance Document. It addresses this issue with enhanced LPM labeling requirements. Manufacturers must include a warning that explains problems due to patient age and the risk of spreading malignancy outside of the uterus. Labeling must also include information about LPM containment systems during laparoscopic gynecologic surgery.
The FDA’s morcellator labeling guidelines prompted a reduction in laparoscopic surgeries. In many cases, doctors have returned to performing higher-risk abdominal procedures.
Do You Need a Hysterectomy Injury Attorney?
If your doctor damaged your bowel or bladder or caused other unintended injuries during your hysterectomy, you may have a right to recover damages. As you must comply with formal malpractice guidelines, you should consult with a hysterectomy injury attorney as soon as possible. To pursue this medical malpractice case, you must present evidence from a medical expert. You must also meet high standards that prove your physician acted negligently and/or did not meet the standard of care.
Most medical malpractice attorneys offer a free initial consultation to discuss the strength of your case and describe the process of pursuing compensation for your injuries. This consultation comes with no obligation to file a lawsuit. You simply discuss your case and learn more about your legal options.
