FTM Hysterectomy

FTM Hysterectomy / Bilateral  Salpingo-oophorectomy (BSO) in Bangkok, Thailand 

          Hysterectomy with and without salpingectomy/oophorectomy is considered by WPATH to be a necessary component of gender affirming surgical therapy for transmen who choose to seek this procedure. Hysterectomy has been successfully combined with other gender affirming surgeries performed in the same operating suite including vaginectomy, mastectomy, and genital reconstruction such as metoidioplasty or phalloplasty. Kamol Hospital provides FTM hysterectomy 4 techniques as follows below;

1. Laparoscopic technique:

          Instead of making a large incision, the new only makes a few tiny incisions through which thin instruments pass through the abdomen. This new technique significantly reduces scaring, pain, healing time, blood loss, and duration of hospital stay when compared to the open procedure.

 the_scar_of_Laparoscopic_Hysterectomy_technique

Picture 1 shows the scar of the laparoscopic hysterectomy technique.

2. Abdominal Hysterectomy with Bilateral Salpingo-oophorectomy (BSO) or Open Technique

             A transverse incision is an abdominal wall, usually above the pubic bone, as close to the upper hairline of the individual's lower pelvis as possible, similar to the incision made for a cesarean section approximately 4-5cm long. This technique allows the surgeon the most exceptional access to the reproductive structures and performs for removal of the entire reproductive complex. Abdominal hysterectomy is the most common method. The recovery time for an open hysterectomy is 4–6 weeks.
 

the_scar_of_Abdominal_Hysterectomy_or_Open_technique

Picture 2 shows the scar of an abdominal hysterectomy or open technique.

 

3. Subsequently the Vaginal or V technique:

            Vaginal hysterectomy is performed entirely through the vaginal canal and has clear advantages over abdominal surgery such as fewer complications, shorter hospital stays, and quicker healing time. If this technique is complicated, surgical exploration will be required. 

4. Natural Orifice Transluminal Endoscopic Surgery Hysterectomy with Bilateral Salpingo-oophorectomy (BSO) & Oophorectomy or NOTE technique

           A new technique removes the uterus and ovaries. Developed from total laparoscopic hysterectomy and transvaginal hysterectomy procedures, which provide more safety.  The surgeon inserts a vaginal speculum into the vagina and inserts the shield into the vagina to protect the cervix. Then the surgical instrument is inserted into the vagina. After dissection, both uterus and ovaries are removed from the vagina opening.

 Hysterectomy_by_NOTES_technique

Picture 3 shows the process of NOTES technique Hysterectomy

 

Advantage of NOTES technique Hysterectomy

  1. No scar
  2. Less postoperative pain
  3. Shorter hospital stay and quick recovery of bowel function
  4. Shorter recovery and faster return to daily activities
  5. Less complication from bleeding during surgery or less chance of injury in the abdomen

Preparation for Hysterectomy Surgery

  • Gather information. Learn as much as you can about having a hysterectomy. Make sure you understand how the procedure will go, as well as what is involved in the recovery process.

  • Lose weight, if you’re overweight. Being overweight can increase the risks associated with surgery and anesthesia, and severe obesity can increase surgery time and blood loss. If you’re overweight, talk to your doctor about the best way to go about losing weight before your surgery.

  • Stop smoking. Stopping or cutting down on smoking as much as possible can help with general anesthesia and recovery from surgery, Smokers may have problems breathing during surgery, and they tend to heal more slowly afterward.

  • Discuss your medication with your doctor. Talk to your doctor about whether you need to change your usual medication routine before having a hysterectomy. You should also let your doctor know about any over-the-counter medications, such as aspirin, or dietary supplements you’re taking. Some supplements can help prepare you for a hysterectomy. For example, taking a daily multivitamin can help improve general health, and vitamin C can help promote healing. Talk to your doctor about recommended supplements you might take before your hysterectomy surgery.

  • Make sure other medical conditions are well-controlled. If you have diabetes, high blood pressure, sleep apnea, or other medical conditions, check with your doctor to make sure they’re under control before you have a hysterectomy. When other pre-existing conditions are managed,

  • Eat light. Limiting heavy foods and avoiding big meals can help you feel better before and after the procedure. “Eating healthy is always important, but even more so when you plan to have surgery.

Postoperative Care for Hysterectomy

          1. After having a hysterectomy, you will feel tired and in some pain. This is normal after this type of surgery. You will get a painkiller
          2. You may have a drainage tube in your abdomen (if you have had an abdominal hysterectomy) to take away any blood from beneath your wound – these tubes usually stay in place for 1 to 2 days
          3. You may have a gauze pack inserted into your vagina (if you have had a vaginal hysterectomy) to minimize the risk of bleeding – this usually stays in place for 24 hours
          4. The day after your operation, you'll be encouraged to take a short walk. This helps your blood to flow normally, reducing the risk of complications developing, such as blood clots in your leg 
          5. After the catheter has been removed, you should be able to pass urine normally.
          6. Any stitches that need to be removed will be taken out 5 to 7 days after the operation.

Recovery 

          The length of time it'll take before you're well enough to leave the hospital depends on your age and your general level of health. If you have had a vaginal or laparoscopic hysterectomy, you may be able to leave between 1 and 4 days later. If you have had an abdominal hysterectomy, it'll usually be up to 5 days before you're discharged.
It can take about 6 to 8 weeks to fully recover after having an abdominal hysterectomy. Recovery times are often shorter after a vaginal or laparoscopy hysterectomy.
During this time, you should rest as much as possible and not lift anything heavy, such as bags of shopping. Your abdominal muscles and the surrounding tissues need time to heal.
 
          Returning to work. If your job does not involve manual work or heavy lifting, it may be possible to return after 6 to 8 weeks. Your doctor will advise you when you can return to work. This can be anything from 2 to 6 weeks after your operation. Do not lift any heavy objects during your recovery period. If you have to lift light objects, make sure your knees are bent and your back is straight.
 

Risks and complications:

After having a hysterectomy, you may have some temporary side effects.
          1 Bowel and bladder disturbances
          After your operation, there may be some changes in your bowel and bladder functions when going to the toilet. It's recommended that you drink plenty of fluids and increase the fruit and fiber of your diet to help with your bowel and bladder movements. For the first few bowel movements after a hysterectomy, you may need  laxatives to avoid straining. Some people find it more comfortable to hold their abdomen to provide support while passing a stool.
          2. Vaginal discharge.
          After a hysterectomy, you'll experience some vaginal bleeding and discharge. This will be less discharge than during a period, but it may last up to 6 weeks.
          Please visit the doctor if you experience heavy vaginal bleeding, start passing blood clots or h,ave a strong-smelling discharge.
          3. Menopausal symptoms
          If your ovaries are removed, you'll usually experience severe menopausal symptoms after your operation. These may include:
          • hot flushes
          • anxiety
          • weepiness
          • sweating
          You may have hormone replacement therapy (HRT) after your operation. Pleaseult your hormone therapist
          4. Emotional effects
          You may feel a sense of loss and sadness after having a hysterectomy.
 

Before and After Hysterectomy with BSO

the_scarless_of_NOTES_technique 

Picture 3. Shows the scarless of a NOTES technique

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