Laparoscopic Hysterectomy

The laparoscope has been in use in surgical procedures as early as the 1970s. Gynecologists have long been using the laparoscope for surgical procedures such as tubal ligation, tubal pregnancy treatment, and the removal of fibroids and ovaries.

However, the laparoscope has only been recently used for hysterectomies, with the first laparoscopic hysterectomy being performed in 1988 in Pennsylvania.

What is a Laparoscope?

A laparoscope is a tiny camera inserted into the body and used to view internal organs and perform minimally invasive surgical procedures.

What is Laparoscopic Hysterectomy?

Laparoscopic hysterectomy is an alternative to abdominal hysterectomy. The gynecologist is able to remove the uterus, cervix, and ovaries through tiny abdominal incisions. These incisions are typically about a quarter of an inch. The laparoscope allows the gynecologist to examine the reproductive organs within the abdomen prior to performing the hysterectomy and determining whether or not the ovaries should be removed as well. Like in an abdominal hysterectomy, the cervix may be kept when a laparoscopic hysterectomy is performed.

With hysterectomy being one of the most commonly performed surgeries in the United States, the development of laparoscopic hysterectomy greatly improves patients’ experiences when undergoing hysterectomy:

Below are the benefits that laparoscopic hysterectomy has over abdominal hysterectomy:

• Reduced hospital stay from a few days to a few hours
• Reduced post-surgical pain; less pain medication requirements
• Quicker recovery
• No large abdominal incisions or scars

Techniques in Performing a Laparoscopic Hysterectomy

There are three techniques for performing laparoscopic hysterectomy, namely the Laparoscopically Assisted Vaginal Hysterectomy (LAVH); the Total Laparoscopic Hysterectomy (TLH); and the Laparoscopic Subtotal Hysterectomy.

Laparoscopically Assisted Vaginal Hysterectomy (LAVH). A vaginal hysterectomy is preferred over an abdominal hysterectomy because a vaginal hysterectomy results in shorter hospital stay, less pain, and quicker recovery.

The use of a laparoscopy makes it possible to perform a vaginal hysterectomy when pelvic pathology such as endometriosis, pelvic adhesions due to previous abdominal surgeries or infections, pelvic masses, etc., may prevent a vaginal hysterectomy. During a laparoscopically assisted vaginal hysterectomy, the doctor makes small incisions on the abdomen where the laparoscope and trocars are inserted. This enables the doctor to look at the organs inside the abdomen and safely remove the uterus through the vagina.

Total Laparoscopic Hysterectomy (TLH). A gynecologist with advanced laparoscopic skills can remove a very large uterus thru the vagina and close the vaginal cuff laparoscopically.

With the use of a laparoscope, the size of the incision is less than half an inch, while still allowing for a large-sized uterus to be removed. The large uterus can be reduced to a smaller size in the abdomen with a morcellator prior to its removal from the body via the vagina.

With the procedure being less invasive, patients usually feel less pain and recover much faster than when undergoing a traditional abdominal hysterectomy.

Laparoscopic Subtotal Hysterectomy. This type of laparoscopic hysterectomy is also known as laparoscopic supracervical hysterectomy. This type of hysterectomy makes it possible to remove a woman’s uterus without removing her cervix. The uterus is amputated from the cervix. The uterus is reduced to a smaller size with a morcellator and removed in pieces thru the tiny abdominal incisions. The vagina remains intact along with the cervix. This procedure should be done only in women who do not have a history of cervical dysplasia (pre-cancerous cervical cells) or cervical cancer.