Condition/Cause

Hysterectomy is the removal of the uterus surgically and it is one of the most frequently performed operations. The most common indications for the hysterectomy are uterine fibroids, endometriosis, adenomyosis, abnormal uterine bleeding, pelvic pain, pelvic mass, cancer. For many years the only option for the women in need of a hysterectomy was abdominal hysterectomy (performed through an abdominal incision) or vaginal hysterectomy. Now for the past one decade another option is available, a laparoscopic hysterectomy (performed laparo-scopically in total).

About the Procedure

A total laparoscopic hysterectomy of a normal uterus takes less than sixty minutes, while difficult cases may take up to 2-3 hours. A 10 mm belly button incision together with three other 5 mm incision is used.

Laparoscopic hysterectomy is the procedure which involves complete laparoscopic dissection until the uterus is freed from all its attachments in the peritoneal cavity. Uterus is either delivered through the vagina or morcellated abdominally and vaginal incision is sutured.

A very important feature of this technique that I use is the preservation of the length of the vagina at total laparoscopic hysterectomy using vaginal tube. The uterosaccral ligments (which provide the support for the vagina) are not cut unlike other methods of hysterectomy as well as hysterectomy by laparoscopic by laparotomy (open abdominal incision) so less chance of vault prolepses post-operatively. Another important aspect of the total laparoscopic hysterectomy technique is the suturing of the vaginal fault and the uterosaccral ligaments to prevent future prolapse.

Recovery

Patients mostly stay overnight and are discharged within 24hrs. Less than 10 percent of woman stay for two nights and this is usually because the operation is the more extensive with treatment of endometriosis or severe pelvic inflammatory disease.

Some patients have returned to work within three days even driving themselves, while a more usual recovery time is around two weeks.

Expectations

With the laparoscopic approach to the hysterectomy, the operative time is short, pain is minimized during recovery, blood loss is minimal, hospital stay is shortened, and overall cost of surgery is less, asthetically leave minimal scars. We feel that this technique is a gentler form of hysterectomy which benefits every woman who will require a hysterectomy.

Complications

Injuries to the bladder or uterus may occur during hysterectomy whether it is performed vaginally, by open laprotomy or by laparoscopy. Bowel injury may occur when there is extreme adherence of the bowel. Most injuries that are detected during laparoscopy are treated at laparoscopy without resorting to laparotomy. Other complications are more generic related to surgery in general or laparoscopy.

Our experience at Batra Hospital

In the last few months I have done 17 total laparoscopic hysterectomies. The uterus was normal size in 7 cases, 10-14 week size in 7 cases, 2 cases had previous 2 caesarean section, and one case had 1 caesarean section. The operative time was two hours in simple case and 3-4 hours in complicated cases but none had any significant complication.
Patients were allowed oral fluids within 12 hrs of surgery were mobile within 24hours, were on full diet in 48 hrs, minimal pain relievers were required in the post-operative period. Patients were discharged from the hospital on full diet after 2 days of the surgery.

In Summary

With the development of the sophisticated surgery tools and the advanced thermal energies and technique of hysterectomy has become simplified and the average gynecologist cab add to his or her armamentarium a safe, readily mastered, time efficient hysterectomy technique that offers the prospects of consistently good outcome.