Robert MacDermott - Consultant Gynaecologist
   
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Laparoscopic Hysterectomy




 What is a laparoscopic subtotal hysterectomy?

It is a "keyhole" operation to remove the womb. It is called total when the cervix is removed, or subtotal when it is not.

 What is Laparoscopy?

Laparoscopy is an operation in which a telescope is inserted through the umbilicus (belly button) to inspect the pelvic organs i.e. uterus (womb), fallopian tubes and ovaries.

 Who might benefit from a laparoscopic subtotal hysterectomy?

It is used to treat painful and/or heavy periods, as well as cancer of the womb. Like all hysterectomies, it is not suitable for women who might want to have children in the future.

 Can my ovaries be removed at the same time?

Yes. Some women will chose to have their ovaries removed either to treat endometriosis or to reduce their future risk of developing ovarian cancer.

 Is this procedure suitable for women who have had abnormal smears in the past?

You should discuss this with me so that I can advise.

 Will it definitely stop my periods?

The vast majority of women will not have any further periods. If you keep your cervix, there is a small chance (about 1 in every 25) that you will continue to have a slight monthly bleed / discharge due to the presence of glandular tissue in the canal of the cervix.

 How is the operation performed?
  • General anaesthetic is administered
  • Your bladder is emptied with a catheter.
  • An instrument is introduced through your cervix into your womb so that it can be moved as required to help visualise the pelvic organs.
  • A small incision (1cm) is made inside the unbilicus.
  • A needle is introduced via the incision into the abdominal cavity, which fills the abdomen with gas (carbon dioxide). This allows the pelvic organs to be seen more clearly. The telescope (laparoscope) is inserted.
  • Up to three other small incisions are made to introduce other necessary instruments into the abdominal cavity.
  • The blood supply to the womb is cauterised. The womb is then removed from the abdomen, either through the vagina or using a special instrument known as a morcelator which cuts the womb up into pieces which can pass through one of the instruments.
  • The top of the vagina is sutured either via the telescope or through the vagina.


 Are there alternative treatment options?

There are a number of different treatments for heavy periods. These include tablets, both hormonal and non-hormonal.
  • A progesterone-releasing coil (Mirena) can easily be fitted in your womb and this reduces menstrual bleeding and pain in 80% of women.

  • You could have a more simple operation to remove the lining of your womb (Endometrial Ablation). This is performed as a day case and is effective at reducing menstrual bleeding and pain in 80% of women.

  • Hysterectomy can also be performed through a larger cut in your abdomen. It can sometimes be performed by a vaginal approach without any cut in your abdomen.

 Is it better than a traditional hysterectomy?

Women recover much more quickly from a laparoscopic hysterectomy than a traditional hysterectomy. However, the risk of serious complications is similar with the two types of surgery. The possible complications are described below.

 Is it a safe procedure?

Without performing a hysterectomy, laparoscopy is a common, relatively safe procedure. However, it does carry some risk and this risk is higher because of the hysterectomy and also if you are obese, have had previous abdominal surgery or have pre-existing medical problems. Possible risks include:
  • Risks from anaesthesia Your anaesthetist will also be able to answer any questions you may have before the operation.
  • Injury to bowel/bladder/ureter/major blood vessels this may occur on entry into the abdominal cavity with any of the previously mentioned instruments. If necessary, the operation will be converted to a "laparotomy" (i.e. a larger incision will be made on your abdomen) to repair any injury caused. You may need to have a blood transfusion if a blood vessel is injured. Your hospital stay may be prolonged if these complications occur. Some injuries do not become apparent until a day or two after the operation and may require repeat surgery.
  • Infection Serious infections of the pelvis are rare. Minor infections of the wound sites or bladder (cystitis) may occur and usually respond to a course of antibiotics that you can obtain from your GP.
  • Deep venous thrombosis and Pulmonary embolus. This is the formation of clots within your leg veins which can become dislodged and travel to your lungs, Although potentially extremely serious, it is not common and you will be given stockings and blood-thinning injections to help prevent clots forming.
  • Failure to be able to remove the womb via the laparoscope. This occasionally happens due to adhesions or the size / position of your womb. In this situation I would need to make a larger cut in your abdomen.
  • Bruising this should settle after a week or so.
  • Shoulder tip pain this is fairly common and results from the gas introduced into the abdomen. The gas may irritate a nerve under the diaphragm, which also supplies the shoulder.

 When will I go home after the operation?

You will usually be able to go home on the day following your operation.

 When can I go back to work?

People vary in how quickly they recover after surgery. Depending on your job you may be able to return to work 2-4 weeks after the operation, as long as you feel well.

 When can I drive?

You should be able to drive 2-4 weeks after the operation as long as you feel comfortable doing so.

 When can I have sexual intercourse?

After 6 weeks usually.

 What about the stitches?

Dissolving stitches are used. These usually fall out in 1-2 weeks.

 Will I need to have cervical smears in the future?

If you keep your cervix, then yes.

Author - Robert MacDermott, March 2006. Updated 2017














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