What is laparoscopic hysterectomy?
Laparoscopic hysterectomy is the surgical removal of the uterus through small incisions (up to 1 cm) in the abdominal wall. The proportion of hysterectomies performed laparoscopically for benign gynecological disease has increased considerably in recent years.
Indications for laparoscopic hysterectomy
The indications are: fibroids (benign tumors arising from the muscular wall of the uterus), endometriosis (a condition in which the cells that normally line the inside of the uterus grow elsewhere in the body), uterine prolapse, menstrual abnormalities, chronic pelvic pain and gynecological cancers.
Types of hysterectomy for benign gynecological disease
There are different types of hysterectomy for benign gynecological disease:
- Total hysterectomy (the cervix is removed as well)
- Subtotal hysterectomy (the cervix is left in place)
- Hysterectomy with removal of one or both fallopian tubes and ovaries
All three of these types of hysterectomy can be performed laparoscopically.
How laparoscopic hysterectomy is performed
- Laparoscopic hysterectomy is carried out under general anesthesia.
- Depending on the indication for surgery and the surgeon's usual practice, 3 or 4 small abdominal incisions are needed.
- The surgeon uses a fine needle to fill the abdomen with carbon dioxide, distending it and reducing the risk of injury to the organs inside.
- A small camera (the laparoscope) is inserted through one of the incisions and lets us see the organs magnified and in great detail.
- The remaining incisions are used to introduce the surgical instruments with which the hysterectomy is carried out.
- The uterus — together with the tubes and ovaries, if their removal is indicated — is removed through the vagina, and the vagina is closed laparoscopically with absorbable sutures.
Recovery after surgery
Discharge and full recovery — most patients are able to go home within 24 hours of the end of the operation. In general, full recovery after laparoscopic hysterectomy takes 2 to 4 weeks.
Healing of the surgical wounds 5 days after laparoscopic hysterectomy
Pain after surgery
Pain after the operation is usually mild, lasts a few days and is controlled with simple painkillers. Shoulder-tip pain is common; it is caused by irritation of the diaphragm by the carbon dioxide and settles soon after surgery.
Absorbable sutures
The incisions are closed with absorbable sutures or skin glue, so nothing needs to be removed afterwards. After a total hysterectomy (where the cervix is also removed) there are absorbable sutures inside the vagina as well.
Reducing the risk of thrombosis
To reduce the risk of clots in the veins of the legs, you need plenty of fluids and to get moving again quickly after surgery. Your gynecologist may also recommend heparin injections (low molecular weight heparin) for at least a week after the operation.
Advantages of laparoscopic hysterectomy
Compared with abdominal hysterectomy, laparoscopic hysterectomy offers:
- A considerably faster recovery
- Less pain after surgery
- A shorter hospital stay
- A lower risk of surgical wound infection
- A better cosmetic result, because the incisions are small
Laparoscopic hysterectomy may involve a longer operating time and a slightly higher risk of injury to the urinary tract (bladder, ureters). However, in the hands of a gynecologist with substantial surgical experience, the length of the operation and the risk of complications do not differ significantly from abdominal hysterectomy.
Vaginal hysterectomy generally offers similar advantages to laparoscopic hysterectomy. It may not be possible, however, in the case of:
- A uterus that has not descended (no prolapse)
- Adhesions from previous operations
- A large uterus (for example because of fibroids).
- An indication to remove the tubes and ovaries along with the uterus
In conclusion
The majority of hysterectomies for benign gynecological disease can be performed laparoscopically. Laparoscopic hysterectomy has substantial benefits and, in the hands of a gynecologist with considerable surgical experience in this particular operation, it can be carried out very safely. The number of hysterectomies performed this way is expected to rise further in the future.