Total Laparoscopic Hysterectomy


What is laparoscopic hysterectomy surgery?

A laparoscopic hysterectomy is a minimally invasive surgical procedure to remove the uterus and cervix with or without the ovaries. A small incision is made in the navel through which a tiny camera is inserted. The surgeon watches the image from this camera on a TV monitor while performing the procedure. Two to three other tiny incisions are made in the lower abdomen. Through these, specialized instruments are inserted and used for the removal process.

How is a Laparoscopic Hysterectomy done?

The procedure is performed under a general anaesthetic by a gynaecologist. A drip is inserted into your arm. A catheter (a tube for urine drainage) is inserted after you have been anaesthetised. A small incision is made either in or just below your umbilicus. The abdomen is inflated with gas and an optical instrument, called a laparoscope (similar to a telescope) is inserted to visualise the internal organs. Further small incisions may be made on your abdomen. The uterus and cervix are removed with or without both ovaries vaginally. The wounds are closed in layers. The procedure itself takes approximately one to two hours.

What are the advantages of laparoscopic hysterectomy surgery?

A laparoscopic hysterectomy requires only a few small incisions, compared to a traditional abdominal hysterectomy which is done through a 3-5 inch incision. Visualization of pelvic anatomy is superior with laparoscopy. As a result, there is less blood loss, less scarring, and less post-operative pain. A laparoscopic hysterectomy is usually done as an outpatient procedure whereas a traditional hysterectomy usually requires a 5-7 days hospital stay. The recovery period for this laparoscopic procedure is 1-2 weeks, compared with 4-6 weeks after a traditional hysterectomy.

The risks of blood loss, pain, infection and scarring are lower with laparoscopic hysterectomy than with abdominal hysterectomy. In experienced hands, laparoscopic hysterectomy takes about the same length of time as abdominal hysterectomy and involves no greater risk.

Who should have laparoscopic hysterectomy surgery?

Fibroids – These are benign tumors that grow inside the uterus. Fibroids can cause persistent bleeding, anemia, pelvic pain, and/or bladder pressure.

Endometriosis – This is a condition in which uterine tissue grows outside the uterus—on the ovaries, fallopian tubes, or elsewhere in the body. Endometriosis can cause painful menstrual periods and/or heavy bleeding, and can sometimes cause infertility.

Adenomyosis – Here the tissue that lines the womb begins to grow within the muscle wall of the womb. This can cause severely painful periods. In peri-menopausal or menopausal women, hysterectomy may be a treatment option where all other alternatives have failed.

Uterine prolapse – If the ligaments and tissues supporting the uterus become weakened, the uterus can slip down into the vagina. Uterine prolapse can lead to urinary incontinence, a feeling of pelvic pressure, or difficulty with bowel movements.

Gynecologic cancer – Hysterectomy is often part of treatment for cancer of the uterus, cervix, ovaries, and/or fallopian tubes.

Persistent vaginal bleeding – Heavy, irregular periods that consistently last longer than 5–7 days may be treated with hysterectomy when other treatments are ineffective.

Pelvic inflammatory disease – This condition occurs due to bacterial infection of the female reproductive system. In the early stages, it can be treated with antibiotics. However, if the infection spreads, it can lead to long-term damage and pain. In these cases, a hysterectomy may be considered.

Chronic pelvic pain – In some cases, no cause is found for this condition. Hysterectomy may be performed as a last resort when other treatments have failed.

What preparations will be needed prior to surgery?

Any investigations or consultations arranged at the preoperative consultation should have been completed, to make sure there are no medical conditions that may cause a problem during the surgery. Patients should not eat or drink anything after midnight on the night before surgery. The bowel preparation medication should be taken as ordered. You should continue your regular medications, unless advised otherwise. Should you develop an illness prior to your surgery, please contact your surgeon immediately.

What should I do on the day of the procedure?

Unless otherwise specified, you should stop eating and drinking at the following times on the day of the surgery:

At midnight for a morning procedure or

At 6 am for an afternoon procedure

You should continue all your usual medications, unless otherwise specified.

What type of anaesthesia will be required when performing hysterectomy?

Patients are put to sleep under general anaesthesia.

Is there a hospital stay after surgery?

85% of our patients go home the same day as their surgery.

What should I expect after the procedure?

When you wake from the anaesthetic, you will be in the recovery room. A drip will be maintained for one to two days and the catheter will normally be removed the same day or following day. You should expect a stay of 1 to 2 days in hospital.

What kind of a recovery can be expected?

Patients should expect to take antibiotics and painkillers for a few days post-operatively. We encourage patients NOT to stay in bed. They should move around the house and resume normal activities as soon as they feel up to it. Some women are well enough to return to work one week after surgery.

After discharge from hospital, what I should do ?

Eat and drink normally

Remain mobile

Use sanitary pads (not tampons) if required

Shower normally

You should not:

Have intercourse for 6 weeks

Undertake any heavy lifting or straining for 6 weeks