Laparoscopic Hysterectomy: Purpose, Steps, Video, Recovery

Laparoscopic hysterectomy is a minimally invasive approach used to remove the uterus. The method utilises specialised instruments and a camera (laparoscope) inserted through small keyhole incisions. This allows surgeons to visualise the internal organs and precisely perform the surgery.

Anatomy of the Uterus

The uterus, also known as the womb, is an organ located in the pelvis between the bladder and rectum. It significantly contributes to reproduction and the development of a foetus during pregnancy. The major parts include:

1. Fundus: The upper, rounded uterus region where the fallopian tubes attach and a fertilised egg implants during childbirth.

2. Body: Also known as the corpus, this is the central portion between the fundus and the cervix. It is where the foetus develops during pregnancy.

3. Cervix: The lower, narrow portion connecting to the vagina. It has a small opening referred to as cervical os, allowing menstrual blood to flow.

4. Endometrium: The inner uterine lining that thickens and sheds during the menstrual cycle. This is where implantation of a fertilised egg occurs when a woman is pregnant.

Laparoscopic hysterectomy is used to treat various gynaecological conditions affecting the uterus. It offers effective treatment options by accessing the organ through small incisions.

1. Uterine Fibroids: Non-cancerous uterine growths that cause pelvic pain, heavy menstrual bleeding, and pressure symptoms.

2. Endometriosis: A condition where the tissue lining the inside of the uterus grows outside of it. This leads to pelvic pain, irregular bleeding, and fertility issues.

3. Uterine Prolapse: It refers to the uterus lowers into the vaginal canal due to the weakened pelvic floor muscles. It causes symptoms like pelvic pressure, urinary incontinence, and discomfort.

4. Gynaecological Cancers: Uterus removal surgery may be recommended to treat uterine, cervical, or ovarian cancers, depending on the stage and extent of the disease.

Uterus removal surgery is suitable for patients seeking relief from symptoms or those requiring treatment for conditions affecting the uterus. Physical indications for laparoscopic hysterectomy include:

1. Heavy menstrual bleeding (menorrhagia) that does not respond to medication or other conservative treatments.

2. Severe pelvic pain or pressure.

3. Chronic pelvic inflammatory disease (PID) or recurrent pelvic infections that do not respond to antibiotics or other therapies.

4. Complications related to childbirth, such as anaemia, postpartum haemorrhage, and perineal tear.

Laparoscopic hysterectomy has a high success rate of approximately 95.3%, making it a widely favoured surgical option for various gynaecological conditions. The primary benefits associated with this procedure are:

1. Minimally invasive approach, resulting in smaller incisions and reduced risk of infection.

2. Faster recovery time than traditional open surgery, allowing patients to resume their daily activities in 1 to 2 weeks.

3. Less postoperative pain and reduced need for pain medication.

4. Minimal scarring leads to improved cosmetic outcomes and increased patient satisfaction.

Before a laparoscopic hysterectomy, patients undergo evaluations. This may include a medical history review and examinations. The entire process is described below.

Before Surgery 

Before surgery, the patient must arrange for someone to take them home. This is because the effects of anaesthesia and pain medication can impair their ability to drive safely.

On the Day of Surgery

On the day of surgery, patients should arrange for transportation home. This is because anaesthesia and pain medication may make it unsafe to drive or travel alone.

The laparoscopic surgery for uterus removal takes around 2 to 4 hours to complete. The following would happen during this treatment:

1. Patient Positioning: The individual is positioned in the dorsal lithotomy position, lying on their back with knees bent and legs elevated. This allows optimal access to the pelvic area.

2. Anaesthesia: Before surgery, the patient is administered general anaesthesia to ensure comfort and unconsciousness throughout the procedure.

3. Incision: Small cuts, ranging from 5 to 12 millimetres, are made in the abdomen to insert the laparoscope and surgical instruments.

4. Gas Insufflation: Carbon dioxide gas is introduced into the belly to create space for the surgeon to work and to improve the visibility of internal organs.

5. Visualisation: A laparoscope, a thin tube with a camera, is inserted through one of the incisions. This enables the doctor to view the pelvic organs on a monitor in the operating room.

6. Dissection: Specialised instruments guided by the laparoscope, detach the uterus from surrounding tissues, blood vessels, and ligaments.

7. Removal: Once detached, the uterus is removed through the incisions in the abdomen. In some cases, the cervix or other structures may also be removed, depending on the patient's condition.

8. Closure: After removal, the cuts are closed with sutures or surgical adhesive. Small bandages may be placed to aid in healing.

Following laparoscopic hysterectomy, patients may experience mild discomfort, fatigue, and vaginal bleeding. It's important to follow post-operative guidelines provided by the doctor to promote healing and ensure a smooth recovery process.

The Recovery Process in Hospital 

Depending on the patient’s situation, they may be discharged within 24 hours. However, some women may require a hospital stay of one to three days if they have the surgery due to cancer. 

In Hospital Recovery

After getting discharged from the hospital, patients can expect a laparoscopic hysterectomy recovery time lasting around 2 to 6 weeks. Key points regarding the healing process include:

1. Light bleeding, soreness, and discomfort in the abdomen, lasting 1 to 2 days.

2. Patients can begin short walks from the third day to promote circulation.

3. In 1 to 2 weeks, they can gradually start light activities. 

4. Strenuous work-out must be avoided for 4 to 6 weeks.

5. Most patients can return to work within 2 to 4 weeks following surgery.

First Follow-up Appointment

Six weeks following surgery, patients will attend their first follow-up appointment with their healthcare provider. During this visit, the practitioner will conduct a vaginal examination to assess healing and check for any abnormalities. Additionally, they will inspect the incision site for signs of bruising or swelling.

Laparoscopic hysterectomy is associated with a low complication rate, approximately 8.07%, making it a generally safe option. However, like any procedure, there are potential risks, including:

1. Risk of injury to surrounding organs, such as the bowel, bladder, or blood vessels, during surgery.

2. Possibility of post-operative infection at the surgical site.

3. Adverse reactions to anaesthesia, including nausea, vomiting, or allergic reactions.

4. Development of veins of legs and lungs (deep vein thrombosis)

When to consult a doctor?

It's important to consult a doctor promptly if patients experience any concerning symptoms following a laparoscopic hysterectomy. The situations in which seeking medical attention is advised are:

1. Persistent or worsening abdominal pain that does not improve with medication.

2. Excessive vaginal bleeding, especially if accompanied by passing large blood clots.

3. Strong-smelling vaginal discharge.

4. Signs of infection like fever or redness.

Delaying uterus removal surgery can lead to the progression or worsening of underlying conditions such as uterine fibroids and endometriosis. Additionally, more complications related to the symptoms, such as anaemia due to heavy menstrual bleeding, may develop.

Uterus Removal Surgery Cost

The cost of uterus removal surgery, mainly laparoscopic hysterectomy, can differ based on various factors, such as the hospital or surgical facility chosen. The approximate costs are provided below.

Note: These figures are subject to change. Contact HexaHealth to get up-to-date pricing information.

Factors that may affect the cost of laparoscopic surgery for uterus removal include:

1. Type of Hysterectomy: The specific kind of laparoscopic hysterectomy performed can impact the cost. It can either be total (removal of the cervix and uterus) or partial (removal of the uterus only).

2. Surgeon's Fees: The doctor's experience, expertise, and reputation can affect their professional charges.

3. Preoperative Testing: Expenses associated with blood tests, imaging studies, and consultations with specialists may add to the overall bill.

4. Post-operative Care: Follow-up appointments, medications, and any necessary post-surgery treatments can contribute to the total cost of surgery.

5. Health Insurance: The extent of coverage and any out-of-pocket expenses, deductibles, or co-payments can influence the final amount of laparoscopic hysterectomy.

Laparoscopic hysterectomy offers a minimally invasive approach to uterus removal surgery, providing patients with numerous benefits. These include reduced post-operative pain, faster recovery times, and smaller incisions. By opting for this method, patients can quickly return to their daily activities.

For those considering a laparoscopic hysterectomy procedure, HexaHealth can provide top-notch care. With our network of experienced gynaecologists and modern facilities, we can guide patients through every step of the way. Get in touch!

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