Laparoscopic Hysterectomy
Laparoscopic hysterectomy utilizes the latest minimally invasive surgical techniques to remove the uterus through small finger-width (1cm) abdominal incisions. This procedure is indicated for heavy and irregular menstruation unresponsive to medical management, symptomatic fibroids, or pelvic pain from endometriosis/adenomyosis or pelvic adhesive disease.
First, air is used to inflate the abdomen like a balloon. Typically, three small one centimeter incisions are made on the abdominal wall. Small trocars or ports are placed through these incisions. The laparoscope is placed through one of these ports and operating instruments are placed through the other two. Using advanced dissecting devices such as the harmonic scalpel, the uterus is separated from its blood supply and supporting structures. It is then truncated from the cervix, morcellated and removed from the abdomen in small pieces. The cervix is left in place to maintain sexual sensation and function. It also serve as a prevention for future pelvic floor or vaginal apex prolapse. The ovaries can be easily removed at this time or left in place as desired for their endocrine/hormonal function. The instruments are then removed from the abdomen, the gas is released, and each incision is closed with a single stitch. The procedure takes from one to two hours to complete. Patient typically spends two to four hours in the recovery room and discharged home on the same day. Time out from work is one to two weeks.
Risks associated with this procedure are rare, and may include bleeding, infection, damage to underlying organs, need for a larger abdominal incision to complete the procedure or treat complications. Please note that since the cervix is left in place the risk for cervical cancer does not change. Likewise, if the ovaries are left in place the risk for ovarian cancer remains the same. This risk is not increased but it is also not reduced as in the case when these structures are removed. Routine follow up for health maintenance and cancer screening is still warranted.
Clear advantages of this procedure over the traditional abdominal or vaginal hysterectomy include: Shorter surgery and anesthesia time - usually one to two hours Smaller incisions - less scarring, less hernia, wound infection, and wound separation risks Significantly less blood loss Less post-operative pain - usually easily managed with oral analgesic rather than intravenous narcotics Faster recovery, shorter hospital stay - usually day surgery Less time out from work - typically one to two weeks Disadvantages of this procedure include: Not widely available - only a few centers have the facility for this type of surgery. These centers must also have the nursing skills to maintain and utilize the wide array of equipments required. Need for surgeons with advanced training and technical skills - again reducing the availability of this type of surgery. High up front cost - equipments and supplies for this surgery are generally very expensive. This cost, however, is balanced by the reduction in the cost of the shortened hospital stay and recovery time. Contraindicated in cases of suspected uterine malignancy or extremely large uterus.
Insertion of the Trocar
This video shows how a trocar or port is placed in abdominal cavity under laparoscopic visualization. These ports are used to introduce the operating instruments into the abdominal cavity which is now inflated like a baloon.
Dissection of the Uterus
This video shows how the uterus is dissected free from its blood supplies and support structures.
Truncation of the Uterus
This video shows how the uterus is truncated from the cervix.
Morcellation of the Uterus
This video shows how the uterus is morcellated and removed from the abdominal cavity. An instrument called the morcellator simultaneously cut the uterus into pieces and remove it from the abdominal cavity. Note that at this point there is no further blood loss.