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Laparoscopic Hysterectomy

What is a Hysterectomy?

A hysterectomy is a surgical procdure where a woman's uterus is removed.

Why is a Hysterectomy needed?

There are many reaons why a woman might need a hysterectomy. The commonest ones are as below
  • Heavy menstrual bleedin
  • Fibroids of the uterus
  • Cancer of the uterus/cervix/ovaries
  • Severe uterine infection
  • Endometriosis
  • Prolapse of the uterus
  • Post menopausal bleeding

Hysterectomy ends your ability to become pregnant. If you think you might want to become pregnant, ask your doctor about alternatives to this surgery. In the case of cancer, hysterectomy might be the only option. But other conditions — including fibroids, endometriosis and uterine prolapse — have alternative treatments that you can try first.

Hysterectomy - the different methods that it can be performed

A hysterectomy can be performed through an incision in your abdomen (abdominal hysterectomy) or through your vagina (vaginal hysterectomy). Which procedure is best for you depends on your specific situation.

Abdominal hysterectomy

In abdominal hysterectomy, the surgeon cuts through skin and connective tissue in your lower abdomen to reach your uterus. The surgeon uses one of two types of abdominal incisions for the hysterectomy. A vertical incision starts in the middle of your abdomen and extends from just below your navel to just above your pubic bone. A horizontal bikini-line incision (Pfannenstiel incision) lies about an inch above your pubic bone.The advantage of an abdominal procedure is that your surgeon can see your uterus and other organs and has more room to operate than if the procedure is done vaginally. For this reason, your surgeon may opt for the abdominal procedure if you have large tumors or if your doctor suspects the presence of cancer.On the other hand, abdominal hysterectomy can mean:You'll be in the hospital longer.You will experience greater discomfort than following a vaginal procedure.You'll have a visible scar on your abdomen.A 4" to 6" incision is made across the abdomen.Abdominal hysterectomy will leave a visible scar on your abdomen.The uterus and cervix are removed.  

Vaginal hysterectomy

In a vaginal hysterectomy, the surgeon reaches your uterus by making a circular incision around the cervix. This approach is best for benign conditions that lead to hysterectomy when the uterus isn't too large. It's often the best approach for uterine prolapse. With a vaginal hysterectomy, you won't have any external scarring. You may also recover more quickly because you aren't waiting for a large abdominal incision to heal and the nerve signals from the top of the vagina aren't perceived in the same manner as those from the skin. However, vaginal hysterectomy gives the surgeon less room to operate and no real opportunity to view your pelvic organs. 

Laparoscopically - Total Laparoscopic Hysterectomy - THE GOLD STANDARD 

Laparoscopic hysterectomies have now been made much safer with the advent of the Harmonic Scalpel. Till the Harmonic Scalpel came about [and still in most centers in India], the instrument used for hysterectomies is the "Bipolar Electrosurgical Unit". The Harmonic is much safer, faster and has many advantages over the older "electro surgery". The surgeon makes a small incision near your navel to insert a thin device (laparoscope) that allows the surgical team to see inside your abdomen. Through other tiny incisions, your surgeon uses special surgical instruments to detach the uterus and then remove it through your vagina.Total laparoscopic hysterectomy [TLH] is a procedure where the entire hysterectomy is done laparoscopically and the uterus may either be removed via the vagina
or morcellated [cut up into small pieces], and removed thru the keyholes in your abdomen. 

TLH, or total laparoscopic hysterectomy is now considered the gold standard or standard of care as far as hysterectomies are concerned.

Laparoscopic Hysterectomy - Advantages over open hysterectomies

  • Less tissue trauma  
  • Less blood loss - few ml versus half a liter in open surgery  
  • Less postoperative pain - patients walk on the same day  Faster recovery - patients can get back to work in a couple of days versus weeks that open surgery  
  • Requires Shorter hospital stay - 1 day versus 4-5 days for open surgery  
  • Better cosmetic results - smaller scars      
  • Less chances of wond infection     

Myths surrounding Hysterectomies

  1. I will put on weight and early menopuase :- Mood changes,dry skin etc are a sign of menopause. Menopause accures when both the ovaries are removed and the production of the hormones stop. In a hysterectomy only the uterus is removed. We retain the ovaries even in a post menopausal women. 
  2. A long recovery period with bed rest :- Almost all women who undergo a laparoscopic hysterectomy are home the next day and back to work or all normal activities within a week to 10 days. 
  3. A hysterectomy is very painfull :- As we perform only laprscopoic hysterectomy,the cuts are very small and not painful,you can walk by evening and eat normal food too. 
  4. 1 will have a huge ugly scar :- No, a laparoscopic hysterectomy is done through a few small incissions( a cuts)which heal very well. 
  5. Sex is not enjoyable :- On the contrary some women enjoy sex more become. -The fear of pregnancy is no longer -Any condition like a deep fibroid which was earring painful inter course is eliminated. 
  6. I will have back pain :- This is again sign of menopause when women do not take calcium,Since your ovaries are left intact you will not experience back pain. 
WHAT HAPPENS TO ME AFTER A HYSTERECTOMY :- 

You will be relived of your symptoms like heavy period,painful periods etc. 

The only changes that you will see in your body is -
  • you will not get your preiods, and
  • you will not be able to get pregnant

Laparoscopic Hysterectomy or Laparoscopic Myomectomy?

I HAVE FIBROIDS - MYOMECTOMY OR HYSTERECTOMY. 

Myomectomy - is a surgical procedure to remove uterine fibroids leaving the utreus. So you can have children in the future.

Hysterectomy - is a surgical procedure to remove the entire uterus and fibroid, leaving behind the ovaries. So:

  • you will not be able to concieve in the future
  • but you will have no menopausal symptoms (like weight gain), and other issues that occur after menopause, since the ovaried are left behind.
WHEN IS A HYSTERECTOMY DONE 

You should choose a Myomectomy instead of a hysterectomy only if 
  • You are planning a future pregnancy, as, The uterine fibroids might be the cause of infertility
WHY IS A HYSTERECTOMY A BETTER OPTION?

  1. Chance of recurrance - following the myomectomy the fibroids can recur. The younger you are the higher the chance. This puts you at a risk for multiple surgeries in the future, and every next surgery is more difficult, and more complicated.
  2. A myomectomy takes longer and it is slightly more major procedure has compared to a hysterectomy. 
  3. The fibroids are removed by a process of' Morcellation' which takes time. 
  4. A myomectomy needs a few layers of stitches on the uterus which can take time to heal.
CAN A HYSTERECTOMY BE DONE IN A YOUNG PATIENT?

Age is not a criteria in deciding between a hysterectomy and myomectomy. If you have a finished child bearing and are not planing a further pregnancy go for a hysterectomy. Infact the younger you are:

  • The higher the chance of fibroids recurring and higher chance of further surgeries following a myomectomy. 
  • You have more years to attain menopause. So you will have to suffer the symptoms for a longer time. 
Do not the be scared of hysterectomy. The recovery period is short, less painful and no loss of feminity or menopause ( as the ovaries are left behind). Make the correct decision. Far too often, I advise patients a hysterectomy, as they have decided not to have any more children, but they decide to go for a myomectomy. Often due to wrong advise that they recieve from friends and/or family. They come back a few years later and regret the wrong decision, as they again need surgery.

The ultimate choice is ALWAYS the patients, but please make an 'INFORMED' choise, which means, that one makes a choice KNOWING all the pros and cons of each surgery.

MINIMAL INVASIVE SURGERY 

Whether you decide on a myomectomy or a hysterectomy do see out a surgeon who specialises in laparaoscopy. We offer laparoscopic procedures, otherwise known as ' Key hole surgery' or ' Minimally invasive surgery'

Laparoscopic Hysterectomy - Some final thoughts

The decision about which kind of hysterectomy to have is an important one. Remember, it's usually an elective procedure, not an emergency. Give yourself some time to thoroughly understand your options. Talk with your doctor.

Learning all you can - and asking questions about those issues that are most important to you - is the best way to feel confident that you are making the very best decision possible.Understanding your treatment options is a big step toward taking control of your life. You've taken that first step. Now take the next one.
 
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