A conventional hysterectomy involves removing the uterus (womb) through an abdominal incision or through the vagina. The cervix may be removed along with the uterus (total hysterectomy) or it can be left in situ (subtotal or supracervical hysterectomy).
A laparoscopic hysterectomy is carried out by a gynaecologist using key-hole or laparoscopic surgery, where much smaller incisions are made in the abdomen to access and detach the uterus and sometimes the fallopian tubes and ovaries. Different terms are used to describe the procedure (laparoscopic hysterectomy (LH), total laparoscopic hysterectomy (TLH) and laparoscopic assisted vaginal hysterectomy (LAVH)), depending on the extent of surgery carried out via the laparoscope. Removal of the fallopian tubes and ovaries is known as salpingo-oophorectomy.
A laparoscopic procedure results in a much quicker recovery from the operation, and minimal scarring of the skin.
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Laparoscopic hysterectomy is done whilst you are asleep under general anaesthesia. A manipulator is placed in the uterus via the vagina and a laparoscope is introduced through a small incision in the umbilicus. A urinary catheter is inserted to drain urine from the bladder. This will usually be removed on the morning after your operation. Two further small incisions are made in the lower abdomen, to provide access for additional surgical instruments. The remainder of the procedure varies according to the amount of surgery performed laparoscopically.
A haemostatic cutting device such as monopolar or bipolar diathermy scissors, stapling gun or harmonic scalpel is used to detach the uterus from surrounding and supporting structures including ligaments and blood vessels. The uterus is then removed through the vagina, or may be cut into small pieces, and removed through one of the abdominal ports.
Hysterectomy is performed for a wide range of conditions, including uterine malignancy, and benign conditions, such as fibroids, heavy periods and pelvic pain, that have not responded to medical treatment. Depending on the indication for the hysterectomy and your age, removal or conservation of the tubes and ovaries and hormone replacement therapy will be discussed with you.
The alternative to this surgery is to decide not to have surgery and the implications of deciding not to have surgery will be discussed with you. Other forms of treatment available for your particular condition (such as heavy periods) would have been discussed with you by Mr Chilcott. Laparoscopic hysterectomy may not be suitable for all women. It may then be appropriate to consider an abdominal or vaginal hysterectomy.
The potential advantages are less pain and a shorter recovery time. As only small cuts need to be made, the scars following laparoscopy are much smaller. Most women are able to leave hospital the day after surgery and return to work after four weeks.
You must have nothing to eat or drink for six hours before the operation (even if you are at home). Unless you have been told not to take your regular medication, continue to take them as usual but take them with as small amount of water as possible.
When you wake up from your operation you will be in the recovery room and you will stay there for approximately 20-30 minutes before you are taken back to the ward by one of the nurses. Initially you may feel drowsy and nauseous but this is normal and it will soon pass. You will bleed slightly from your vagina after the procedure and your nurse will monitor this. You may also experience some pain in your abdomen, neck and shoulders. This is due to your abdomen being inflated with carbon dioxide, which can collect beneath your diaphragm causing a feeling of discomfort in your shoulders. You will have been prescribed regular pain killers by the anaesthesist. However, please ask your nurse for some more painkillers if you require them. Usually following surgery you will be able to drink fluids when you are ready and have breakfast the next morning. You will usually be able to go home the next day after your surgery, depending on your condition afterwards.
- A responsible adult must collect you from hospital and escort you home in a car or taxi, and then stay with you overnight.
- You must not drive for about 3-4 weeks following your operation.
- Any vaginal bleeding should be minimal and may last for between seven and 10 days. If you experience any heavy bleeding and/or worsening pain, contact Mr Chilcott via the hospital.
- You should only return to work when you feel well enough and are able to manage your normal activities. Most women will need at least three to four weeks off.
Your incision sites will be closed with dissolvable stitches.
- Only resume your normal sexual activity once you feel comfortable and all bleeding has stopped.
If you do not experience any complications during the operation there should be no adverse long-term effects. However, if you had your ovaries removed you might experience menopausal symptoms such as hot flushes, night sweats and low mood. You should discuss with your doctor regarding hormone replacement therapy.