Hysterectomy and adnexectomy

What is hysterectomy and adnexectomy?

The hysterectomy and adnexectomy is the surgical technique by which the uterus and ovaries are extirpated. This operation has the goal of avoiding the effect from female hormones that the ovaries produce, as well as possible illnesses that may settle in the internal female genitalia, which seem to be boosted by the consumption of male hormones. It is also the basis of surgery following sex reassignment.

The operation

The patient will be admitted to the hospital centre on the same day as the operation. During those hours, pertinent monitoring will be conducted and the intestine prepared, as well as the region to be affected by the operation.

The hysterectomy and adnexectomy is performed under general anaesthesia. The medical team at the Gender Unit of Dr Ivan Mañero Plastic Surgery Institute will perform the operation, choosing the most suitable technique in each case. There are three basic paths by which the operation may be undertaken:

Abdominal entry: This consists of making a small, lower abdominal incision that will later be concealed by the pubic hair. From this incision, the uterus and ovaries will be removed.

Laparoscopic entry: This technique requires making three separate incisions, through which a gas is introduced (carbonic anhydride) which bloats the abdomen. Using laparoscopic clamps to enter the abdominal cavity, the uterus and ovaries are extracted.

Vaginal entry: This technique is highly complex to apply in transsexual patients and is ruled out from the start, since it is used in the cases of patients with uterine prolapse or in extreme cases of extremely dilated vaginas due to prior childbirth.

Using any of the three approaches described, the final goal of radical anexohisterectomy (removing uterus and ovaries) is to access the abdominal cavity and separate the uterus and ovaries from their places of insertion and their blood supplies, with final extraction of both organs and careful closure of the abdomen.

The performing of this operation by an experienced surgeon enables procedures to be undertaken that leave the area prepared for the later genital gender confirmation surgery. This procedure minimises later complications and ensures a more satisfactory result.

Recovery

The day after the operation the patient may begin eating and may get up and walk (remaining in bed or stretched out horizontally for many hours may delay recovery and even cause a complication). At 48/72 hours after the operation the surgeon may decide to discharge the patient.