A minimally invasive surgical procedure, a laparoscopic hysterectomy is used when a patient’s condition requires the removal of the uterus. The procedure consists in the insertion of a very small camera through the belly button. The doctor will then watch the images on a screen and perform the operation using specialized instruments. Let’s discuss the procedure and the benefits it has over the open, or abdominal hysterectomy.
What Is a Laparoscopic Hysterectomy?
A laparoscopic hysterectomy makes use of a laparoscope. This is a thin tube with a lighted camera put through an incision near the belly button. Surgical tools are also inserted through a small dime size incision in the belly button or several other tiny cuts. The camera records the insides of the body and a surgeon will perform the hysterectomy from outside the patient’s body. The whole procedure is viewed on a video screen.
Laparoscopic Hysterectomy vs. Open Surgery: The Advantages
The advantages of laparoscopic hysterectomy, first of all, are in the amount of scarring. Because this type of surgery requires only a few small incisions, there is less scarring, less blood loss, as well as much less post-operative pain. Consider the fact that abdominal hysterectomy is performed through 6 – 9 inch incisions.
Much of the time, a laparoscopic hysterectomy does not require an overnight hospital stay. However, in the U.S., insurances will allow a patient to stay 23 hours for the same price, if a patient desires. But, being an outpatient procedure, the absolute recovery period is also reduced – around one to three weeks. In an open surgery hysterectomy, the recovery time spans up to six weeks, and the patient also requires up to three days of hospital stay. More specifically, patients with a laparoscopic hysterectomy can drive the next day and return to work or normal life as early as 1 week if they desire, whereas, with an open abdominal hysterectomy the patient is in the hospital 3 days and not allowed to drive for 14 days, or return to work for 6 weeks.
A laparoscopic hysterectomy does not take longer than an abdominal hysterectomy, taking about the same length of time. As for the risk of infection, it’s worth mentioning that a laparoscopic hysterectomy patient faces lower risks of developing a postop infection.
Types of Laparoscopic Hysterectomies
There are three types of laparoscopic hysterectomy:
Laparoscopically Assisted Vaginal Hysterectomy (LAVH)
A laparoscopically assisted vaginal hysterectomy is a surgery through which the surgeon removes the uterus through the vagina. The ovaries and/or fallopian tubes may also be removed, if need to. Then the surgeon places sutures to close the top inside of the vagina by going up through the vagina utilizing retractors and instruments to reach up inside.
Total Laparoscopic Hysterectomy (TLH)
A total laparoscopic hysterectomy, is the same as above in the LAVH, except all of the suturing is done laparoscopically with small laparoscopic instruments. Nothing is done through the vagina except removing the uterus. A Robotic Hysterectomy is a version of the TLH.
Laparoscopic Supracervical Hysterectomy (LSH)
Through a laparoscopic supracervical hysterectomy, the surgeon will remove only the uterus. The cervix is left in place and there is no cutting or suturing in the vagina. This procedure is done by making small dime size abdominal incisions. The uterus is then detached and cut into small pieces, being removed through the abdominal incisions.
Who Can Have a Laparoscopic Hysterectomy?
Laparoscopic hysterectomies can treat abnormal uterine bleeding, fibroids, cramps, and patient’s with pelvic scar tissue, among other conditions. It is, however, not usually done with a uterus bigger than a 4-month pregnancy. Only a specialist can guide you towards the best procedure for your specific medical case.
Generally, women suffering from the following gynecological issues can choose to undergo a laparoscopic hysterectomy:
- Heavy vaginal bleeding that could not be managed through other treatments.
- Fibroids (noncancerous growths).
- Cervical cancer or precancerous cells.
- Uterine cancer
- Pelvic pain unrelieved with other treatments.
- Prolapsed uterus.
- Uterine cramps that don’t respond to other treatments.
Risks Involving Laparoscopic Hysterectomies
A hysterectomy is usually a safe operation. Serious complications are rare, yet they may occur, just as with any major operation. When deciding if this is the right procedure for your condition, you need to weigh in the risks as well as the benefits.
Most of the complications of laparoscopic hysterectomy occur when inserting the instruments. Other possible complications include operative injuries from instruments, thermal and energy source injuries, and human error.
Here is a more comprehensive list of risks patients face with laparoscopic hysterectomies:
- Intestinal injury.
- Urinary system injury (ureter or bladder).
- Abdominal wall hematoma/bleeding.
- Major vascular injuries.
- Pneumoperitoneum complications.
- Gas embolism.
- Vulvar edema/swelling.
- Nerve injury.
- Cardiac arrhythmia.
- Venous thrombosis.
Although laparoscopic surgeries have less complications than open surgery, there’s a certain amount of risk with any procedure. Discuss these concerns and possible risks of the surgery with your doctor.
Many patients leave the hospital the same day as their surgery. Others may spend one night in the hospital.
After a laparoscopically assisted vaginal hysterectomy, a very small percentage of patients may need a catheter until the bladder regains its normal functions which is usually 3-7 days. After the procedure, there may be some pain or discomfort. Most of the time patients report the majority of pain in the left or right dime size incision in their abdomen. Another possibility, that can be minimized preoperatively with medicine, is nausea and vomiting due to anesthesia.
Sometimes a side effect after a surgery is constipation due to pain medications. Therefore it is important that the patient eats a balanced diet, drink lots of fluids, and possibly uses a gentle laxative to help avoid this issue.
If the patient is premenopausal but has her ovaries removed, she will enter menopause. The doctor will prescribe medicine to relieve the symptoms of menopause. Hormone therapy is considered to be the most effective treatment in relieving menopausal symptoms. Discuss the risks and benefits of hormones with your doctor.
Intercourse after laparoscopic hysterectomy should be avoided for six weeks. This allows the sutures at the top of the vagina to heal securely before encountering pressure during sex. Patients should avoid deep penetration until the sutures are healed and the doctor gives “green light” for sex.
Vaginal bleeding and spotting is usually minimal and will resolve in the first week after the procedure. If experiencing heavy bleeding, a foul odor, or urinary or rectal bleeding, call your doctor immediately.
Alternatives to Laparoscopic Hysterectomy
For some women, a hysterectomy may be the only treatment choice they have. But if you suffer from heavy bleeding, endometriosis, fibroids, or other pelvic health problems, ask your doctor about the following alternatives to hysterectomy:
- Uterine artery embolization. This noninvasive procedure consists in injecting small particles into the uterine arteries that feed fibroids. This will cut off their blood supply and allow them to shrink significantly or completely. The key advantage of this procedure is that the uterus is preserved. Some women may avoid further surgery by choosing this option.
- Hysteroscopic Myomectomy. This procedure uses a telescope-like instrument to remove fibroids through the vagina. The recovery time is minimal. However, it should be noted that it is only offered to patients with submucosal fibroids within the lining of the uterine cavity.
- Medicinal drugs. Nonsteroidal anti-inflammatory drugs like Motrin is the first option when treating the symptoms of uterine fibroids. Oral contraceptives are used to treat menorrhagia, endometriosis, and chronic pelvic pain.
- Endometrial ablation. This procedure ablates the lining of the uterus. The techniques used for this operation have a success rate of up to 90%. However, depending on how young a woman is, it may only last a few years.
- Other methods include IUDs, relaxation exercises, and trigger point injections.
Laparoscopic hysterectomies are associated with shorter hospital stay, fewer risks of infection, decreased blood loss, and many other benefits compared with abdominal hysterectomies. While there are risks involved with this procedure as well, it is usually a safe operation with a high satisfaction rate. Many patients leave the hospital the same day, and can usually resume normal activities (except for exercise and sex) in just one week after surgery.
As always, consult with your doctor to learn about the best treatment option for your medical case.
IMAGE SOURCE: Shutterstock