Laparoscopic Hysterectomy
Dr G.D. Reid & Dr H.F. Joyce
Hysterectomy may now be performed in some patients with the assistance of laparoscopy. Laparoscopy involves the introduction of a telescope into the abdominal cavity. A camera is attached to the end of the laparoscope and transmits a high quality image to a video monitor, allowing the surgeon to operate by remote control. A number of other small entry sites are made in the abdominal wall for the introduction of operating instruments.
Types of hysterectomy
The type of hysterectomy performed will depend upon the reason for the operation and the particular circumstances of the patient.
The operation may be:
- Laparoscopic guided hysterectomy (LGVH) - where a laparoscope is used to confirm that a vaginal hysterectomy is safe and to check on control of bleeding at the end of the procedure.
- Laparoscopically assisted vaginal hysterectomy (LAVH) - where part of the hysterectomy is performed through the laparoscope, thus enabling a vaginal hysterectomy to be performed where this would not have otherwise been possible and would have required open surgery in the past.
- Laparoscopic hysterectomy (LH) - where the entire operation is performed through the laparoscope.
- Subtotal hysterectomy (STH) - where part or the entire cervix is conserved but the rest of the uterus is removed.
The Operation
This takes usually 1 - 2 hours but may take longer in difficult cases. A general anaesthetic is required and admission to hospital for 2 - 3 days can be expected.
There will usually be four small puncture sites in the abdominal wall for the introduction of operating instruments. Blood vessels are sealed by using staples, electrocoagulation or conventional stitches and the uterus is removed either through the vagina or through one of the abdominal wall sites after it is divided into smaller pieces (morcellation). Sometimes a drain tube is left in the abdominal wall and it would be usual to have a catheter in the bladder for the first night. It is routine for a drip (IV/intravenous line) to be inserted at the time of operation and for this to remain for the first 24 hours.
After the Operation
It may be necessary to take some analgesia for pain for the first few days and it is normal to have some light bleeding or discharge for 1 - 2 weeks.
Once discharged from hospital, you should continue to feel better as each day passes. In the past it was routine to stay in hospital for about ten days after similar surgery. With early discharge, it is important to monitor your own progress carefully. Don't hesitate to contact your doctor if you feel your progress is not normal.
Activities should be restricted for the first two weeks, after which you are free to do whatever you wish. Sexual intercourse should be avoided for four weeks, or at least until any bleeding or discharge has ceased.
You will commonly notice some redness or irritation around the abdominal stab sites, but these seldom cause major problem. Any area of spreading redness or pain should be reported to your doctor.
A follow up appointment will be made to discuss the findings at the time of your operation, to review any pathology samples taken, and to consider any further treatment that may be required.
Risks of the Operation
Like any surgery, there are risks associated with laparoscopic hysterectomy. The major risk with this procedure is conversion to open hysterectomy which occurs in about 1:100 operations.
Other risks include:
- Excessive bleeding requiring transfusion.
- Perforation of other structures including bowel. Generally this can be repaired at the time of operation but in rare circumstances can require temporary colostomy (diversion of bowel to a bag)
- Ureteric injury requiring further surgery to repair.
- Bladder injury which would need catheter drainage for 7 days after the operation.
Conclusion
There are clear benefits that result from laparoscopic hysterectomy compared with open surgery. If you need a hysterectomy, for a number of reasons you may consider this approach. It is nevertheless important for you to discuss the procedure with your doctor, and feel free to ask any questions that you may have. An understanding of the benefits and the risks in your own case is most important.
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Last updated 24th November, 1998