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Overview

Total laparoscopic hysterectomy involves removal of the uterus and cervix. The procedures assist in the surgical management of various conditions, such as fibroids, uterine prolapse, and cancer. It offers several advantages over open abdominal hysterectomy.

What is a Total Laparoscopic Hysterectomy?

Total laparoscopic hysterectomy is a surgical procedure. It involves the removal of the uterus and cervix. Apart from removing the malignant tumor, the doctor recommends this procedure when non-invasive methods fail to provide relief. If required, the doctor may also remove the ovaries and the fallopian tube. 

Total laparoscopic hysterectomy is a minimally invasive surgery. The doctor performs it with the help of a laparoscope. The other more invasive procedure is total abdominal hysterectomy. However, with advancements in surgical equipment and high-quality post-operative care, the recovery after the surgery is excellent with few complications.

When Do Doctors Recommend Total Laparoscopic Hysterectomy?

There are several conditions in which the doctor may perform a total laparoscopic hysterectomy. Some of them are:

  • Cancerous and precancerous conditions: Patients with cancer of the ovaries, uterus, and cervix may undergo this procedure. The doctor may also advise this procedure in precancerous lesions.
  • Fibroids: Fibroids are benign tumors present on the uterine wall. Patients with this condition experience heavy bleeding, pelvic pain, and painful sexual intercourse. Fibroids may also result in infertility.
  • Endometriosis: In this condition, the uterine tissues grow in other parts of the reproductive system. It usually affects the ovaries, fallopian tubes, and pelvis.
  • Uterine prolapse: The doctor may also perform a total laparoscopic hysterectomy in uterine prolapse. In this condition, the uterus slides down into the vaginal cavity.
  • Adenomyosis: It occurs when the inner uterine wall (endometrium) invades the outer muscular wall. It results in abnormal and painful bleeding, pain during intercourse, and pelvic pain.

How Should You Prepare for Surgery?

It is necessary to prepare yourself, both mentally and physically, before a total laparoscopic hysterectomy. Some of the measures for preparation include:

  • Follow your doctor’s instructions.
  • Gathering comprehensive information helps you take good care before and after the surgery.
  • Avoid smoking as it may interfere with your healing process.
  • If you are overweight or obese, try to lose weight.
  • Discuss your medications with the doctor. The doctor may advise you to stop taking aspirin, warfarin, or ibuprofen before surgery to prevent complications.
  • Drink adequate water to avoid constipation.
  • The doctor may also prescribe a bowel cleansing solution.
  • Relax on the night before surgery. It will help your body during recovery.

How Do Doctors Perform a Total Laparoscopic Hysterectomy?

The surgery usually takes around 2 hours. The doctors perform the surgery under general anesthesia. The steps for total laparoscopic hysterectomy include:

  • The doctor makes an incision in the abdomen near the belly button. The size of the incision depends on the size of the uterus.
  • The doctor inserts the laparoscope, a long, thin tube with a camera at the front, through the incision.
  • The doctor then makes 2-3 incisions to insert other surgical instruments.
  • The doctor may also use carbon dioxide gas to expand the abdomen to allow a clearer view.
  • The doctor removes the uterus from the surrounding tissues and blood vessels with surgical instruments guided by the laparoscope.
  • The doctor then makes an incision on the vagina to remove the uterus and cervix from the body.
  • After the removal of the uterus and cervix, the doctor closes the vaginal incision with dissolvable sutures.
  • In some cases, if the size of the uterus is large, the doctor may use devices such as a Morcellator to cut the uterus into smaller parts before removing them.
  • The doctor closes all incisions with sutures and places dressing over them after completely removing the uterus and cervix.

How is the Recovery after a Total Laparoscopic Hysterectomy?

After the surgery, the paramedical staff shifts the patient to the recovery room. Once the vital parameters are stable, the team transfers the patient to a general ward. The doctor may discharge the patient within 1-2 days after surgery. The recovery time is less in laparoscopic surgery than total abdominal hysterectomy. The doctor may prescribe medication for pain and to reduce the risk of infection. The patient may be able to engage in routine activities within two weeks. Full recovery takes around a month.

What are the Complications of a Total Laparoscopic Hysterectomy?

Like any other surgery, a total laparoscopic hysterectomy may also have some complications. These are:

  • Infection: Exposure of internal tissues during a laparoscopic hysterectomy may increase the risk of infection.
  • Blood loss: Vagina is highly vascular, and an incision on the vagina may result in excessive blood loss.
  • Chronic pain: There is also a risk of chronic pain at the site of the procedure.
  • Spreading of cancer: Surgical removal of the tumor may result in the spreading of cancer. It may also lead to advanced stage progression.
  • Blood clot: The surgery also carries the risk of deep vein thrombosis or pulmonary embolism.
  • Organ injury: There is a high risk of organ damage during surgery. Organs such as the stomach, liver, spleen, intestine, and colon are at risk of injury.

The advantages of laparoscopic surgery over open surgery include less recovery time, reduced blood loss, reduced tissue damage, reduced risk of infection, less scarring, and a shorter hospital stay.

There are several types of hysterectomy surgeries. These are total laparoscopic, open abdominal, supracervical or subtotal, radical, and Robot-assisted laparoscopic hysterectomy.

The uterus is the place where the fetus grows. During a total laparoscopic hysterectomy, the doctor removes the uterus. Thus, it is not possible to have a normal pregnancy post-surgery. However, researchers reported some cases of ectopic pregnancy.

The long-term complications of total laparoscopic hysterectomy are rare. They include chronic pain, pelvic organ prolapse, urinary and bowel incontinence, and sexual dysfunction.

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Komala’s Women Clinic is a multidisciplinary organization dedicated to the advancement of the art, science and practice of reproductive medicine.

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