Hysterectomy refers to the removal of the uterus by a surgical process.
The word ‘laparoscopic’ refers to the path through which access to the uterus is gained.
It can be done in three paths:
- Vaginally – through the vagina
- Abdominally – through the abdominal cavity by making an incision through the various layers
- Laparoscopically – through a fibre-optic instrument inserted through the abdomen
The incision made for laparoscopic surgery is much smaller than the one used in abdominal surgery. In some cases, multiple small incisions can be made. Also, the recovery from major abdominal surgery is longer than laparoscopic surgery for which reason the latter is preferred in modern times.
A laparoscope is a fibre-optic instrument through which the internal organs can be viewed. Since the laparoscope only helps with the viewing, the surgery performed is sometimes referred to as ‘laparoscopic-assisted surgery’. The actual removal of the uterus and other parts has to be carried out using other small instruments.
In a Total Laparoscopic Hysterectomy, the entire uterus may be removed along with the ovaries, and fallopian tubes, or only the uterus may be removed. When one or both ovaries are removed, it is called unilateral or bilateral oophorectomy.
The need for removing the uterus can be preventative or reactive in gynaecological care.
Some of the common conditions treated by Total Laparoscopic Hysterectomy are:
- Fibroids: Hysterectomy is recommended as a final and permanent solution to fibroids and other non-cancerous tumors.
- Distressingly heavy menstrual bleeding and pain: Due to a multitude of conditions, some women have excessive bleeding and pelvic pain. Hysterectomy is prescribed as a last-ditch effort to treat it.
- Endometriosis: Another condition associated with the innermost walls of the uterus growing into the neighbouring organs. It causes extreme pain as well as irregular bleeding during periods.
- Cancer: Advanced cancer of the cervix, endometrial layers, or ovaries may require a hysterectomy.
- In some cases, the uterus may become prolapsed or falling down into the cervix and vagina. Or, the walls of the uterus might thicken to cause a condition called Adenomyosis.
Whatever the reasons for hysterectomy are, it is, in all cases, an absolute last resort.
Hysterectomy is never the first line of treatment. If all other possible lines of treatment have been tried without encouraging results, hysterectomy is considered to avert grave spreading of diseases such as cancer.
Depending on the extent of the malady, only a part of the uterus or the uterus may be removed. When both the uterus and the cervix are removed, it is a Total Hysterectomy. ‘Radical hysterectomy’ is performed in cases of advanced cancer. It involves the removal of the uterus, cervix, and even a part of the vagina.
Since it is a major surgery done under general anaesthesia, it is an in-patient procedure. Sedation and surgery together take up to three hours and then the patient spends the same or more time in the recovery room. The effects of the gas used to inflate the stomach and the general anaesthesia last for the good part of the day. Most patients have their stomach cleaned prior to the procedure. It takes some time for normal bowel movements and digestive functions to resume. This is why at least one night’s stay at the hospital is required.
Depending on the patient’s recovery, monitoring needs in keeping with post-operative factors, and indications based on the patient’s age and specific complications, a longer stay at the hospital might be required.
To help your doctor decide whether a laparoscopic hysterectomy is right for you, it helps to give them a clear picture of your health and lifestyle goals.
Dr. Lavanya Kiran | Senior Consultant – Obstetrics & Gynaecology | Mazumdar Shaw Medical Center, Bommasandra & Narayana Multispeciality Clinic, Electronic City – Velankani & Narayana Multispeciality Clinic, Jayanagar