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All about laparoscopic hysteretomy
DR ALPHY S PUTHIYIDOM 17 June 2023
Hysterectomy
Hysterectomy is a common gynecological procedure which involves removal of uterus. It does not necessarily mean removal of the ovaries. As the main functions of the uterus are reproduction and menstruation, a hysterectomy would therefore mean you no longer can bear children nor have menstruation.
What are the reasons or indications for hysterectomy?
There are many indications for performing a hysterectomy. These include:
- Leiomyomas (fibroid tumors) that are rapidly enlarging and/or causing symptoms such as pelvic pain, pressure (constipation, urinary frequency, heaviness and bloating), or heavy or irregular bleeding
- Uterine prolapse (when the uterus is protruding low into the vagina causing infections, pressure or pain)
- Endometriosis
- Adenomyosis
- Ovarian, cervical or uterine cancer
Except for cancer, a decision on whether to undergo a hysterectomy for other indications is rarely urgent. And so, you should have time to discuss with your doctor the benefits, the risks, and the alternative options before choosing hysterectomy. Hysterectomy is advised in women who do not wish to remain fertile and want to be 100% assured of relief of symptoms.
What are the alternative options for hysterectomy?
There are many indications for performing a hysterectomy. These include:
There are many conservative treatment options before choosing hysterectomy. The available options obviously depend upon the underlying problems. For instance, women who suffer from menorrhagia (heavy menstruation) may consider medical therapies, Mirena IUCD, or one of the endometrial ablation methods. Women with fibroids who have not started or completed child bearing may have the fibroids removed Myomectomy. Women with endometriosis who suffer from pain and infertility frequently benefit from excision of endometriosis.
What are the different methods of doing hysterectomy?
The three main methods of hysterectomy are:
- Vaginal Hysterectomy – The vaginal route is suitable where the uterus is prolapsed and is not too large. The entire hysterectomy is performed through the vaginal route.
- Abdominal Hysterectomy – The abdominal route remains the common method of hysterectomy. But it is not the ideal method due the bigger cut in the abdomen, more pain and longer stay in hospital compared to laparoscopic hysterectomy.
- Laparoscopic Hysterectomy – The laparoscopic route is a minimally invasive surgical procedure to remove the uterus. It is performed through three to four small skin incisions, is a safe and effective alternative method to abdominal surgery when performed in the hands of surgeons trained in laparoscopic surgery.
The route of surgery is often determined by the indication for hysterectomy, the severity of the pathology, and the surgical skills and experience of the surgeon. While it is natural for most women to go for the least invasive method, ultimately, you should discuss with your doctor who will advise and choose the safest route for your hysterectomy.
Video of laparoscopic hysterectomy
Different types of Laparoscopic hysterectomy
- Total Laparoscopic hysterectomy – Removal of the uterus and cervix. The ovaries are preserved. In pre-menopausal women, this means there is no change in hormonal status.
- Laparoscopic Subtotal hysterectomy – The cervix of the uterus is preserved. Routine cervical screening is necessary.
- Total Laparoscopic hysterectomy and bilateral-salpingooophorectomy – Removal of the uterus, cervix, ovaries and fallopian tubes – in pre-menopausal women this would mean a loss of ovarian hormones. In turn, this means you will go into menopause. In postmenopausal women, there is no hormonal change as the ovaries have already stopped functioning.
- Laparoscopic Radical hysterectomy – Complete removal of the uterus, cervix, with the parametrium (ie, round, broad, cardinal, and uterosacral ligaments) and the upper one-third to one-half of the vagina. The surgeon usually also performs a bilateral pelvic lymph node dissection. Radical hysterectomy is done in cases of Cervical cancer and in advanced uterine carcinoma.
The route of surgery is often determined by the indication for hysterectomy, the severity of the pathology, and the surgical skills and experience of the surgeon. While it is natural for most women to go for the least invasive method, ultimately, you should discuss with your doctor who will advise and choose the safest route for your hysterectomy.
Dr. Alphy S Puthiyidom
MBBS, MD(Obs&Gn),FMIS(Laparoscopy)
Head of the Department Obstetrics & Gynecology
Advanced Gynecological Laparoscopic Surgeon
& Pelvic Reconstructive Surgeon
MEDICLINIC WELCARE HOSPITAL
Al Garhoud, Dubai
MEDICLINIC PARKVIEW HOSPITAL
Umm Sequim, Al Barsha South 3, Dubai
Appointments 800-1999