Laparoscopic Hysterectomy

What is hysterectomy?

Hysterectomy is a common surgical procedure that involves the removal of the uterus.

What are the different approaches to hysterectomy?

Hysterectomy can be performed by many techniques:

  • Abdominal hysterectomy: This is the standard technique that involves a long incision. Recovery is painful and slow, taking up to six weeks for you to resume your normal activities.
  • Vaginal hysterectomy: This involves a transvaginal approach to the removal of the uterus.
  • Laparoscopic-assisted vaginal hysterectomy (LAVH): A part of the surgery is performed transvaginally and the rest is completed using a laparoscope.
  • Total laparoscopic hysterectomy: This is a keyhole surgery performed through small incisions made in the navel or abdomen.

What is laparoscopic hysterectomy?

Laparoscopic hysterectomy is a minimally invasive surgery to remove the uterus. Along with the uterus, your surgeon may also remove the ovaries.

What are the indications for laparoscopic hysterectomy?

Laparoscopic hysterectomy may be indicated for:

  • Uterine fibroids
  • Pelvic organ prolapse
  • Abnormal uterine bleeding
  • Removal of premalignant or malignant tumours
  • When access to the uterus is difficult because of the presence of adhesions

How do I prepare for laparoscopic hysterectomy?

You will be advised to stop eating or drinking anything at least 6 hours before the procedure. Discuss all the medications that you are taking on a regular basis so that your doctor can advise you on the ones that you can safely continue and those that may need to be stopped during the time of surgery.

How is laparoscopic hysterectomy performed?

Laparoscopic hysterectomy is performed using a narrow long lighted tube with a camera attached. Your surgeon makes a small incision to insert the laparoscope. The images captured on the camera are transmitted to a large monitor, which helps your surgeon to clearly view the surgical site. With the help of small surgical instruments inserted through other small incisions, your surgeon separates the uterus from the surrounding organs and blood vessels, by ligating and sealing the open ends. The uterus is then removed via the abdominal incision or vagina. Your surgeon will remove the ovaries only if you have a risk of developing ovarian or breast cancer. Usually, the ovaries are spared.

What can I expect after laparoscopic hysterectomy?

Following laparoscopic hysterectomy, you may be able to go home after a night’s stay in the hospital. You will be prescribed pain medication to keep you comfortable and advised to move around after the surgery.

What are the advantages of laparoscopic hysterectomy?

The advantages of a laparoscopic hysterectomy are:

  • Smaller incisions
  • Reduced blood loss
  • Less scarring
  • Lower post-operative pain
  • Shorter hospital stay and recovery

Describe the stages of recovery and care plan?

You can start exercising 4-6 weeks after surgery and have intercourse 8 weeks after surgery. You are advised not to lift any heavy object until 4-6 weeks after surgery. If your ovaries are removed as well, you will be prescribed hormone therapy to avoid premature menopause and the symptoms such as hot flashes, that are associated with it.

What are the potential complications of laparoscopic hysterectomy?

Laparoscopic hysterectomy may be associated with complications such as

  • Infection
  • Bleeding
  • Blood clots
  • Conversion to an open surgery
  • Hernia
  • Bowel obstruction
  • Injury to neighbouring organs
  • Rarely, death

What is the downtime of laparoscopic hysterectomy?

You will usually be able to resume your normal work within a week. If you engage in physically demanding work, you are advised to rest for 2 to 3 weeks.

What is the cost of laparoscopic hysterectomy?

Any costs involved will be discussed with you prior to your surgery.

What are the current research regarding laparoscopic hysterectomy?

Extensive research is being done to find better treatment outcomes for laparoscopic hysterectomy. Some of the recent studies are listed below:

  • Committee Opinion No. 701 Summary: Choosing The Route Of Hysterectomy For Benign Disease. Obstet Gynecol. 2017 Jun;129(6):1149-1150.