The first laparoscopic hysterectomy was performed in the United States of America in 1989. Since then the use of "key hole surgery" to assist hysterectomy has increased greatly. In spite of this the tradition abdominal hysterectomy is still performed in a majority of cases. (For further information on the types of hysterectomy see - hysterectomy information sheet). Vaginal hysterectomy is still the safest way to have a hysterectomy performed. In patients who are unsuitable for a vaginal hysterectomy the laparoscope may be used to convert an abdominal hysterectomy into a laparoscopically assisted vaginal hysterectomy.
In cases where vaginal hysterectomy is feasible a laparoscopy performed at the same time may still benefit you by:
Abdominal hysterectomy is still required in some circumstances, for example in cases of cancer, or in patients with a large fibroid uterus.
In most cases abdominal hysterectomy can be avoided by the use of keyhole surgery techniques. Laparoscopically assisted or total laparoscopic hysterectomy has many benefits for the patient.
These include:
Recent studies have shown that patients who undergo a laparoscopic hysterectomy are at no greater risk of complications than those who have an abdominal hysterectomy.
Laparoscopic hysterectomy is an operation where the uterus (womb) is removed. You may require a hysterectomy for one or more of the following reasons.
Laparoscopic (keyhole) surgery involves the use of instruments specially designed to pass through small (5mm) incisions in the abdominal wall to operate on the uterus from inside the abdomen. The uterine supports are divided using these instruments and the uterus is cut free from the top of the vagina. If you are having a laparoscopically assisted hysterectomy then the lower attachments of the uterus to the vagina are divided using traditional surgical techniques. (see vaginal hysterectomy)
The uterus is then removed through the vagina. A large fibroid uterus can be cut into pieces before being removed. The top of the vagina is then stitched closed with suture material.
Surgery usually takes around two hours, which is longer than open surgery. As laparoscopic instruments are very precise there is very little bleeding and minimal postoperative pain.
Hospital Stay: Most women can go home within 3 days of surgery. Some women may want to go home within 24 hours of the operation.
Post operative pain: Within a day of a laparoscopic hysterectomy, most patients require only oral pain medications and are usually up and walking around.
Vaginal bleeding: A small amount of vaginal bleeding is common after a hysterectomy and it may persist for 6-8 weeks. It can sometimes be associated with an odd odour. On rare occasions you may pass some suture material from your vagina 2-4 weeks after surgery. Please report any discharge that is offensive or becomes heavier than a period.
Return to work: Patients can return to non-strenuous employment within a few weeks of surgery.
Return to normal activity: Activities should be limited for 6 weeks after surgery. It is important that you do not do any heavy lifting, cough excessively or strain when opening your bowels for 6-8 weeks after surgery. Light duties can be started within 1-2 weeks. As a general rule, if it hurts do not do it! Intercourse should not be resumed until four to six weeks after surgery or until one week after the bleeding stops.
Pelvic floor exercises: May be commenced when they can be done comfortably, usually within a week or two of surgery.
Role of hormone replacement therapy: If your ovaries have been removed, your oestrogen (female hormone) levels will fall significantly within a few days of surgery. This may cause problems such as hot flushes, sleep disturbance and loss of libido. You may wish to consider hormone replacement therapy and your doctor will discuss this with you.
Post operative pap smears: If you had regular pap smears in the past and they were normal, and your cervix has been removed, you will no longer be required to have pap smears. You should still see your GP for yearly breast and pelvic examinations.
Mood Swings: It is normal to get the blues after a hysterectomy as the operation brings to an end significant symbols of femininity (menstruation and fertility). Please discuss these important issues with your family, friends and medical practitioner.