Laparoscopic Total Hysterectomy
What is Laparoscopic Total Hysterectomy?
It is a relatively new surgical procedure which allows the uterus to be removed from its attachments while it is still inside the body. After the uterus is detached it is removed through through the vagina. It is like the opposite of building a ship in a bottle. This requires special instruments and a doctor trained to use them.
How is the surgery performed?
A small cut is made at the bottom edge of the bellybutton. Through this a thin tube is placed inside the abdomen. A TV camera is attached to the end. This is connected to a monitor which allows the surgeon to see everything inside. After that, two other small incisions are made to allow access for long, thin instruments to carry out the operation. The uterus is then pulled out through the vagina and the vagina is sewed at the top where the uterus used to be.
Why is this surgery better than other types of hysterectomy?
For some people this type of surgery will allow them to return to their normal activities much sooner than a standard hysterectomy with a regular incision. It is used in cases where a vaginal hysterectomy (done with no abdominal incisions) is not possible because the uterus is too high in the vagina to reach.
How is this different from other hysterectomies?
For this procedure the very bottom of the uterus, the cervix, is removed with the uterus. This is where the main support of the uterus holds it in place. So the top of the vagina is opened and then closed again with sutures. This has some advantages and some disadvantages.
What are the advantages?
When the supports of the cervix are cut, the pain fibers that are in them are cut, so there is slightly more pain than if the cervix is left in place. But many patients can be back at work in just two weeks. Exercise and sex cannot resume until six weeks after surgery. However, most daily activities can resume within two weeks.
What are the disadvantages?
If there is a history of abnormal pap smears it may be best to remove the cervix with the uterus. The uterus falling or sliding toward the vaginal opening is sometimes a condition where the whole uterus should be removed also.
Under what type of Anesthesia is it carried out?
This procedure is carried out under general anesthesia.
How long am I in the hospital?
Usually the hospital stay is just overnight. Many patients are simply observed as a 23 hour stay and not technically admitted as inpatients, which may save on out of pocket expense or copayments. Patients stay as long as they need to stay, however. They will not be sent home before they are ready.
What is the difference between this and a Laparoscopic Assisted Vaginal Hysterectomy?
The Laparoscopic Assisted Vaginal Hysterectomy starts the same way with the small incisions to release the upper attachments of the uterus, but ends as a vaginal hysterectomy. In other words, the whole uterus is removed from the vagina after it is released from the top. There are some cases where this might be best, such as if the uterus is large and falling out. Dr. Wiles will discuss all the options that you might benefit from, but if you have questions, please call the office to discuss them.
What about the ovaries?
The ovaries are located just next to the uterus and can either be left in place or removed along with the uterus. It is a choice you have to make. If you are already in menopause it makes the most sense to remove the ovaries as they are no longer functioning and have about 1/250 chance of developing cancer in a woman’s lifetime. Removing them reduces the risk nearly to zero. However, the younger a woman is, the longer she will have the benefit of the most natural hormones available—her own—if they are left in. If one ovary is abnormal, the other one can be left in place and will take over all necessary hormone production.