Hysterectomy

What is a Hysterectomy and what are the reasons for removing the uterus?

Hysterectomy is one of the most common gynecological surgeries. It is the surgical removal of the uterus (womb). The common reasons for hysterectomy are : fibroids (non-cancerous tumors of the uterus), heavy bleeding during periods, prolapsed uterus, endometriosis (causing severe pain and bleeding) and cancer of the uterus and cervix.

What are different types of Hysterectomy?

Total hysterectomy – The entire uterus, including the cervix, is removed.
Subtotal – The upper part of the uterus is removed, but the cervix is left in place.
Radical hysterectomy – This is a total hysterectomy that also includes removal of ovaries and lymph nodes.

What are the different techniques of performing a Hysterectomy?

There are various approaches to conduct a hysterectomy:

A. Abdominal hysterectomy : done by conventional open surgery where the uterus is removed through an abdominal incision.

B. Vaginal hysterectomy: uterus is separated and removed through the birth passage.

C. Laparoscopically assisted vaginal hysterectomy (LAVH).

D. Total laparoscopic hysterectomy (TLH) : Uterus with cervix is separated through tiny keyhole incisions in the abdomen with the aid of a telescope.

How is a Laparoscopic Hysterectomy performed?

A laparoscopic hysterectomy is preferably done under general anesthesia. The surgery involves making three or four tiny incisions over the abdomen. A telescope is introduced and the organs are viewed on a high resolution monitor. The uterus and its supports are separated with special equipment, which reduce blood loss and time of surgery. The uterus is then removed through the birth passage or if it is large removed by morcellation.

Should the ovaries be removed during Laparoscopic Hysterectomy?

In women younger than 50, ovaries are not removed during a hysterectomy. In older women, the ovaries can be removed, as normal functioning of the ovaries usually stops by this age. For women with a gynecologic malignancy or those at high genetic risk of ovarian cancer / breast cancer ovarian removal is indicated.

What is the course of recovery after a Laparoscopic Hysterectomy?

Hospital stay is usually for one day. The patient can resume normal activities within two days. The recovery time is usually a week. It is normal to have mild spotting as the stitches heal. Strenuous exercise and sexual intercourse can be resumed after 10 to 12 weeks.

What happens to sexual life after a Hysterectomy?

Hysterectomy does not affect sexual function. The advantage of laparoscopic hysterectomy is that the vaginal length is maintained and hence intercourse is not affected.

Can all hysterectomies be done laparoscopically?

Today, with advancement in anesthesia monitoring, laparoscopy equipment and techniques along with precise surgical skills and teamwork, nearly all hysterectomies can be done laparoscopically. Worldwide Total Laparoscopic Hysterectomy is accepted as the treatment of choice for removal of the uterus. Laparoscopy can be done even if there is history of previous caesarean sections or if a woman is obese.

What is the new 3D technology in laparoscopy? How is it beneficial to the patient?

Laparoscopy has become the gold standard for all the gynecological surgeries due to its benefits to the patient. 3D laparoscopy is the latest innovation that further increases the safety of surgery. 3D Laparoscopic surgery provides excellent depth perception, definition, and resolution. The relationships of structures are more easily defined, and instrument manipulation is easier. 3D surgeries are safer with lesser complications with advantage of high precision, less bleeding during surgery and less surgical time.