A laparoscopic hysterectomy is a minimally invasive method of removing the uterus through small cuts on the abdomen measuring about 5 to 10mm, with the use of laparoscopic instruments. The uterus is either removed alone, or together with one or both ovaries (called Oophorectomy) and Fallopian tubes (called Salpingectomy).
A laparoscopic hysteroscopy can also be total – removal of the entire uterus, or partial – removal of the upper part of the uterus while leaving the lower part of the uterus and the cervix intact. In this procedure, the uterus can be removed entirely through the abdomen, or it can be removed through the vagina, called a Laparoscopic Assisted Vaginal Hysterectomy (LAVH).
A laparoscopic hysterectomy can be performed for the following reasons – uterine fibroids, cancer or suspected cancer of the uterus, endometrium and cervix, abnormal uterine bleeding, endometriosis, adenomyosis, and uterine prolapse. Some contraindications to having a laparoscopic hysterectomy rather than an abdominal hysterectomy are large fibroids in the uterus, and severe intra-abdominal adhesions (scar tissue inside the abdomen, usually occurring if one has had more than one previous abdominal surgery.
Before the surgery, some tests will be done to check your blood level, heart and kidney functions, blood group, and blood clotting function. If an abnormality is detected or if you have been known to have a previous illness, you might need to be seen by another doctor to be cleared for surgery. If your blood level is low, you will be placed some tablets or injections to raise the blood level, or to prevent you from having another period, so that your blood level doesn’t drop. Once everything is satisfactory, a date can be fixed.
A laparoscopic hysterectomy can only be done under general anaesthesia.
Thin, rodlike instruments are passed through small skin cuts into the abdomen. They are attached to a camera and the images are projected on a screen. A special gas is first introduced into the abdominal cavity, to create space and improve the surgeon’s view. The surgeon is then able to manipulate the laparoscopic instruments to detach the uterus (with or without the ovaries and the Fallopian tubes) under direct visualization. After removal, the uterus is taken out through the abdomen in small pieces. For a Laparoscopic Assisted Vaginal Hysterectomy, the uterus is drawn out through the vagina. The gas is then removed from the abdomen before the skin is closed up.
The procedure takes an average of two to four hours. There is less pain and abdominal discomfort after surgery, and the risk of bleeding and formation of scar tissue between abdominal structures is also reduced.
Women who are premenopausal and have the ovaries removed automatically become menopausal after the surgery. With a partial hysterectomy, because the cervix is left intact there is still a risk of cervical cancer, so routine cervical smears must be continued. Having a laparoscopic hysterectomy alone (without the ovaries being removed) does not negatively affect sexual drive. Sometimes, there is a feeling of a sense of loss after the procedure.
After the procedure, you will be on admission for a day or two, with very few people requiring to stay in for up to four days. There is not so much pain and bleeding after a laparoscopic hysterectomy. Recovery from this surgery usually takes about two to four weeks; after this time regular activities can be resumed.