is the surgical removal of the uterus, most commonly performed for malignancies and certain
nonmalignant conditions (e.g., endometriosis/tumors), to control life-threatening bleeding/hemorrhage, and in the event
of intractable pelvic infection or irreparable rupture of the uterus. A less radical procedure (myomectomy) is sometimes
performed for removing fibroids while sparing the uterus.
Abdominal hysterectomy types include the following:
Body of the uterus is removed; cervical stump remains.
Removal of the uterus and cervix.
Total with bilateral salpingo-oophorectomy:
Removal of uterus, cervix, fallopian tubes, and ovaries is the treatment of
choice for invasive cancer (11% of hysterectomies), fibroid tumors that are rapidly growing or produce severe
abnormal bleeding (about one-third of all hysterectomies), and endometriosis invading other pelvic organs.
Vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy (LAVH) may be done in certain
conditions, such as uterine prolapse, cystocele/rectocele, carcinoma in situ, and high-risk obesity. These procedures
offer the advantages of less pain, no visible (or much smaller) scars, and a shorter hospital stay and about half the
recovery time, but are contraindicated if the diagnosis is obscure.
A very complex and aggressive surgical procedure may be required to treat invasive cervical cancer. Total
pelvis exenteration (TPE) involves radical hysterectomy with dissection of pelvic lymph nodes and bilateral salpingo-
oophorectomy, total cystectomy, and abdominoperineal resection of the rectum. A colostomy and/or a urinary conduit
are created, and vaginal reconstruction may or may not be performed. These patients require intensive care during the
initial postoperative period. (Refer to additional plans of care regarding fecal or urinary diversion as appropriate.)
Inpatient acute surgical unit or short-stay unit, depending on type of procedure.
Psychosocial aspects of care
Surgical intervention (for general considerations and interventions)
Thrombophlebitis: deep vein thrombosis
Patient Assessment Database
Data depend on the underlying disease process/need for surgical intervention (e.g., cancer, prolapse, dysfunctional
uterine bleeding, severe endometriosis, or pelvic infections unresponsive to medical management) and associated
complications (e.g., anemia).
DRG projected mean length of inpatient stay: 2.9–5.9 days
May need temporary help with transportation; homemaker/maintenance tasks
Refer to section at end of plan for postdischarge considerations.
May reveal uterine/other pelvic organ irregularities, such as masses, tender nodules, visual
changes of cervix, requiring further diagnostic evaluation.