What is Laparoscopic uterus removal surgery?
Laparoscopic uterus removal surgery or hysterectomy is an alternative for the conventional abdominal hysterectomy surgery. This does not involve any large incisions for removal of the uterus from the abdomen. Keyhole ports are made through which instruments are introduced in order to perform surgical manipulations inside the abdomen and the uterus is then removed via the vaginal passage. Hence, this procedure is also referred to as laparoscopy assisted vaginal hysterectomy.
The procedure may be combined with removal of the tubes and ovaries, in case indicated or if post menopausal, when the functions of the tubes and ovaries have been accomplished for life. The removal of the tubes is referred to as salpingectomy and of the ovaries is called oophorectomy. Hence the name of the procedure you are to undergo may be named with combination of these terminologies depending on the requisite.
The routes possible for uterus removal are:
- The abdomen, where it is an (open abdominal hysterectomy)
- The vagina, where it can be a total vaginal hysterectomy (TVH) or laparoscopy assisted vaginal hysterectomy (LAVH)
The commonest surgery performed these days is the laparoscopy assisted vaginal hysterectomy or LAVH
Why would you need a uterus removal surgery?
The most common reason for undergoing a hysterectomy is a fibroid uterus. There are several other reasons and they include:
- Heavy menstrual bleeding with intermenstrual bleeding and not controlled by medications or interventions, most commonly due to fibroid uterus
- Uterine prolapse, where the uterine supports are weak and may move down through the introitus causing discomfort
- Uterine tumours including benign fibroids (leiomyoma) and malignant tumours
- Endometriosis and chronic pelvic pain are other indications
What are the symptoms and signs of uterine disease?
The symptoms and signs of uterine disease are:
- Menstrual irregularities: These can include intermenstrual bleeding, post menopausal bleeding, heavy menstrual bleeding or menorrhagia and irregular menstrual cycle with dysmenorrhoeaor painful menstruation
- Urogynaecologicalsymtoms: Increased frequency and urgency of urination, foul smelling discharge per vaginum, urinary incontinence, abdominal bloating, constipation, haematuria and haematochezia
- Constitutional symptoms: Irritability, emotional lability, fever and vaginal discharge with episodes of nausea and vomiting, and fullness in the abdomen
What are the types of diseases where you would need a hysterectomy?
The types of diseases for which a hysterectomy is usually performed are:
- Dysfunctional Uterine Bleed: DUB is a diagnosis of exclusion and is an abnormal uterine bleeding in the absence of any genetic tract pathology or systemic disease or pregnancy. The commonest presentation is menorrhagia or heavy menstrual bleeding with passage of clots and the requirement for frequent change of sanitary pads
- Pelvic Inflammatory Disease: PID is an infection of the upper genital tract. Usually it may follow a lower urinary infection which may ascend to involve the uterus, tubes and even the ovaries. This can be very difficult to treat and need a heavy dose of antibiotics and debridement procedures to drain areas filled with pus.
- Endometriosis: The presence of endometrial tissue outside the uterine cavity is called endometriosis and these tissues menstruate along with the usual cycles and cause a heavy menstrual pain during normal cycles. Sometimes, the endometrial cysts may collect menstrual blood over several cycles to form a chocolate cyst like appearance, especially in the ovary.
- Fibroids: These are benign tumours called leiomyoma, which occur from the smooth muscle tissue forming the bulk of the uterine myometrium. They may be of 3 types:
- Submucosal: Lies within the uterine cavity and may be pedunculated
- Intramural: Lies within the myometrium of the uterus
- Subserosal: Lies under the serosal lining of the uterus
- Adenomyosis: Similar to endometriosis, but the ectopic endometrial tissue lies within the myometrium of the uterine wall itself and causes a lot of pain per abdomen during menstrual cycles.
- Uterine prolapse: When the supports of the uterus become weak, the uterus may descend downwards and appear at the introitus. This can be an uncomfortable feeling especially in day today life. Uterus removal is one of the options, however, mesh repairs for reconstructing the supports of the uterus can also be performed
- Gynaecological cancers: this involves cancer of the cervix, endometrium, tubes or ovaries. The surgical removal of the uterus maybe the only definitive management in early stages. Later stages may require further modes of intervention like chemoradiotherapy as well.
How is a laparoscopic hysterectomy done?
Laparoscopic hysterectomy is a very frequently performed surgery and it involves the following steps:
- The patient is assessed for the need of a hysterectomy, by understanding the medical history and complaints of the patient and confirming the finding with a clinical examination and a series of investigations.
- If the need for a hysterectomy is confirmed, a pre- operative panel of investigations are performed in order to attain fitness for surgery from an anaesthetist.
- Once pre anaesthetic consult is cleared, the date for the surgery is given. You might have to get admitted a day beforehand, depending on your medical conditions to make any adjustments to your medicines and keeping you empty stomach for the procedure.
- Moreover, consent form, which is a legal document to be signed regarding your informed willingness to consent for the surgery will be signed after a brief discussion with your surgeon.
- During the day of surgery, you will be shifted to the operation theatre by considering the rota for the day, and you will be seen by the gynaecologist and the anaesthetist.
- Inside the operation theatre, the anaesthetist will induce the type of anaesthesia chosen to perform the surgery and the gynaecologist will proceed with the surgery, once the anaesthesia is ready
- The patient is positioned and the site of surgery is exposed and cleaned adequately
- The keyhole ports are made on the belly to introduce the camera and instruments. At the umbilicus a trocar is also introduced for creating a pneumoperitoneum to ensure adequate mobility within the abdomen.
- By manipulations, the supports or pedicles of the uterus are cut and haemostasis is achieved, to ensure there is no bleeding
- Supports from the lower ends are also cut in LAVH, and the uterus is finally delivered via the vagina.
- In case tubes are not removed, they are cut and ligated, prior to delivering the uterus.
- Once the procedure is over, the sutures and placed in order to close the ports and the peritoneum from below is also sutured to prevent any herniation.
- Once the surgery is over, you will be recovered from anaesthesia and shifted to the post-operative ward and observed until you are fit to be discharged to the general ward or room.
- Your gynaecologists will review you every day to make sure that everything is perfect and decide on your discharge provided there are no complications like an infection which may prolong your stay in the hospital.
Am I a Good Candidate for Laparoscopic hysterectomy?
The severity of symptoms and discomforts you face are the factors which determine the requirement of the surgery. If you suffer from any of the diseases we have mentioned in the discussions above, perhaps you might require a hysterectomy.
The choice of hysterectomy to be abdominal or vaginal is decided based on the size of the uterus. Moreover, the approach to be open or laparoscopic or robotic needs to address the various parameters with regards to the patient in order to make the decision.
What are the benefits of laparoscopic hysterectomy?
The benefits of laparoscopic hysterectomy are as follows:
- There are minimal scars, unlike in abdominal hysterectomy
- There is a total cure to your problems like heavy menstrual bleeding
- There is less future risk of any uterine cancer
- Any urogynaecological problems or anemia due to blood loss will get corrected over time.
Why Choose MedcureIndia?
MedcureIndia has the country’s finest surgeons and gynaecologists who can help you in making a wise decision to make your life healthier and happier.
We ensure that you get what you were here for.
Your comfort is our aim and we work for it.