Laparoscopic Hysterectomy

Hysterectomy is a surgical removal of uterus, recommended in treatment of endometriosis, uterine fibroids, uterine prolapse, uterine cancer, ovarian cancer and uncontrolled vaginal bleeding. Endometriosis is a common gynaecological problem affecting women of reproductive age. It occurs when the endometrium lining the uterus start growing on surfaces of other organs in the pelvis. Endometrium may grow on ovaries, fallopian tubes, outer surface of uterus, pelvic cavity lining, vagina, cervix, vulva, bladder or rectum. Patients may experience painful cramps in the lower abdomen, back or in the pelvis during menstruation, heavy menstrual bleeding, painful bowel movements or urination and infertility.

Uterine fibroids are the non-cancerous growths in the uterus of women of childbearing potential. Hormone oestrogen has thought to play a role in development of fibroids. These fibroids may be small or large enough to fill the entire uterus. These fibroids may develop in various regions of uterus such as within the wall of uterus, within the inside layer of uterine wall, outside the uterus or within the outside layer of the uterine wall. These fibroids may cause irregularities in menstrual cycle, severe pain, difficult urination, abdominal cramps, constipation, miscarriages and infertility.

Uterine prolapse is the sliding or dislocation of uterus from its position in pelvic cavity into the vaginal canal. Uterus slips down from its position because of weakening of the muscles and connective tissues that hold the uterus in place. Uterine prolapse is often seen in women who had one or more vaginal births. Other risks include ageing, lack of oestrogen after menopause, chronic cough & obesity. Women may experience frequent & urgent urination, low back pain, painful intercourse, bladder infections, and vaginal bleeding.

For all these gynaecological conditions, hysterectomy may be performed but as the last treatment resort. The initial treatment includes conservative treatment options such as pain medications and hormonal preparations and only if these options remain unsuccessful then hysterectomy may be recommended. Also, hysterectomy is performed only if patient is not willing to become pregnant in future.

During hysterectomy, your surgeon may remove complete or a part of uterus, alone or with other surrounding organs such as fallopian tubes and ovaries. The three types of hysterectomies include:

• Partial hysterectomy – Upper part of the uterus is removed without removing cervix (supracervical hysterectomy)
• Complete hysterectomy – Uterus along with cervix will be removed
• Radical hysterectomy – Uterus, upper part of vagina along with the tissues on both sides of cervix will be excised. Radical hysterectomy is most commonly recommended in uterine cancer patients

Hysterectomy may be performed through abdominal hysterectomy (abdominal incision of 5-7 inch), vaginal hysterectomy (vaginal incision), minimally invasive or laparoscopic hysterectomy through abdominal or vaginal incisions. The advanced procedure is robotic-assisted hysterectomy and this procedure is preferred in patients with uterine cancer or if patient is obese and if vaginal procedure is considered unsafe. Your surgeon will decide on the appropriate procedure depending on your medical history and the cause for the uterine hysterectomy.

Total Laparoscopic Hysterectomy

What is total laparoscopic hysterectomy?

Total laparoscopic hysterectomy is a surgical procedure for the removal of uterus. In this technique, the uterus is separated from inside of the body and removed in small pieces through small incisions or through vagina. A hysterectomy is a major surgical procedure and has both psychological and physical consequences.

Why is it performed?

Total laparoscopic hysterectomy is done to treat conditions such as painful or heavy menstrual periods, pelvic pain, fibroids or may be performed as a part of cancer treatment. You should clearly understand the reason for this surgery.

Are there other alternatives to this treatment?

There are other conservative interventions which may be appropriate for your particular condition. Hysterectomy may be performed vaginally, abdominally or laparoscopically. Laparoscopic hysterectomy has benefits such as shorter recovery period, reduced postoperative pain but it may be associated with a greater risk of complications particularly urinary tract injury.

How is a laparoscopic hysterectomy performed?

The procedure is done under general anaesthesia in the operating room. A small incision is made just below your umbilicus. The abdomen is inflated with gas and a fibre-optic instrument called laparoscope is inserted to view the internal organs. Further small incisions may be made on your abdomen through which tiny surgical instruments are passed. Then uterus and cervix are removed along with or without both ovaries and tubes.

What precautions should be taken before the procedure?

You can continue taking your regular medications, unless your doctor advises. You may need to have a bowel preparation which will empty your bowel before the surgery. For this, you should be on a liquid diet (soups, jellies, juices or similar drinks) for 24 hours before the surgery. Avoid smoking and if you develop signs of illness prior to your surgery, please contact our office immediately.

What can be expected during recovery period?

You will be in the recovery room when you wake up from anaesthesia. You may feel sleepy for the next few hours. You may have pain in the shoulder or back which is because of the gas used in the procedure. It resolves within a day or two. You may have some discomfort or feel tired for a few days after the procedure. Contact your doctor if pain and nausea does not go away or is becoming worse. You should avoid heavy activities or exercise until you recover completely.

You may have some vaginal discharge for several days after the procedure. You can return to normal activity by three months, but complete recovery may take longer time. After the procedure, you will no longer be menstruating or be able to conceive.

You may experience bladder and bowel dysfunction and an increased risk of urogenital prolapse.

What are the possible risks and complications of this procedure?

As with any surgical procedure, laparoscopic surgery is also associated with certain risks and complications and they include but not limited to:

• During surgery–Injuries to internal or surrounding organs (bladder, ureters, bowel or blood vessels) requiring further surgery, blood transfusion or longer admission; if the procedure could not be able to be completed laparoscopically you may require an "open" operation(laparotomy)
• After surgery–Infections ( bladder, wound (internal and external), abdomen or lungs); blood clots in the leg, pelvis and/or the lungs; unpredictable wound healing; postoperative pain occasionally necessitating overnight admission, nausea and vomiting
• The anaesthetic complications

Any specific risks and complications will be discussed prior to the procedure.

What if I come across any problem during recovery period?

You should seek immediate medical attention if you experience any of these conditions:

• Fever
• Offensive vaginal discharge or heavy bleeding
• Severe nausea or vomiting
• Inability to empty your bladder or bowels
• Severe pain

Please contact the office on page Dr Mirmilstein on 9387100 or attend the Royal Women’s Hospital Emergency Department if you require urgent attention.