Hysterectomy is most commonly performed gynaecological operation in women. Thousands of women undergo hysterectomy for variety of conditions from endometriosis, Dysfunctional uterine bleeding, Fibroid uterus etc to cancer. Unfortunately more than 85% of these surgeries are still performed by abdominal incision (Laparotomy). This is known as Total abdominal hysterectomy (TAH).
Regardless of the pathology leading to hysterectomy (except cancer) most patients undergoing hysterectomy can have vaginal hysterectomy or Laparoscopic Hysterectomy and should be able to go home after 48 hours. Most are able to resume normal activities between 10-20 days following surgery.
Here is an attempt to answer some of the queries in a patient’s mind:
- What is laparoscopy?
- Laparoscope is a tiny ½” diameter telescope that allows surgeon to look inside the abdomen through a tiny hole at the umbilicus. A variety of surgeries can be performed with its help without making large incision. We can coagulate, cut, suture, repair and remove organ.
- What procedures can you perform with laparoscopy?
- Some of the procedures done laparoscopically include removal of ovary, ovarian cyst, ectopic pregnancy, extensive endometriosis and uterus as well. We can also perform fertility enhancing surgeries such as opening up obstructed fallopian tubes.
- You mean you can do all that through a ½” laparoscope?
- That’s right! With availability of improved video equipment and technology, we do the surgery by looking at the greatly magnified pictures on TV screen with the help of sophisticated camera, telescope, and bright cold light source. We then proceed to identify and separate the surrounding the organs surrounding the uterus, tubes and ovaries with the help of few more instruments through other ports. Telescope allows us to visualize inside the abdomen. As you know uterus and vagina is connected, so once uterus is freed from surrounding tissue the vagina opens up and uterus is removed from the vagina. We can then just close the tip of vagina with few dissolving sutures.
- How many holes will there be on my abdomen?
- Well, one 1cm at the umbilicus and two or three tiny 1/2cm size laterally below umbilicus, that’s all.
- How long the surgery will take?
- About 1 ½ hours on average. However it may vary from patient to patient and surgeon to surgeon.
- What about gas pain? I had it at the time of my sterilization operation.
- You may have little discomfort due to gas, because abdomen is distended by CO2 in order to see the pelvic organs. Once the surgery is over, gas is deflated and CO2 is absorbed within 24 hours, so you should not really have any problem.
- Will I able to have a laparoscopic hysterectomy, if I have large fibroid uterus?
- Yes, you can. Size of the uterus should not matter in performing laparoscopic surgery. Fibroid as large as 10-12cms can also be removed by variety of techniques.
- Is it true, that one can not see as well inside abdomen while performing vaginal or laparoscopic surgery, as while during open surgery?
- Well, laparoscope offers 6-8 times magnification and we can in fact see the entire pelvis much better than we could do so in an open surgery with naked eye. Difficult surgery can precisely be done better in this manner and this is a major advantage.
- Is it risky to have this laparoscopic surgery? Isn’t it better to have it traditional way?
- Procedure is absolutely safe in the hands of a skilled and sufficiently trained Gynecological surgeon. In fact the need for doing an open surgery for benign (not cancerous) conditions has been markedly reduced. We perform such laparoscopic hysterectomy and laparoscopic assisted vaginal hysterectomy in nearly 95% of non cancerous conditions.
- I had a previous open surgery like Caesarean section or appendix; can one perform laparoscopic surgery after this?
- Yes, it can be done with due precautions. Numerous studies have shown this to be completely safe.
- I never been pregnant and never had a normal delivery, can you perform a vaginal hysterectomy?
- Yes it can be done. Laparoscopically assisted vaginal hysterectomy and Total laparoscopic hysterectomy were developed with this situation in mind, where one procedure can be complimenting the other.
- But then why this procedure is not offered by all doctors?
- Well, it’s not a new technique anymore, but many gynecological surgeons are not trained and experienced in this technique. Most can do the open surgery very well (old golden standard); hence the open surgery is recommended.
- Is this surgery very expensive?
- Well, this type of surgery requires many sophisticated electronic gadgets and equipments, which are costly; hence some expenses are bound to be there. However considering the advantages of shorter stay in the hospital, less discomfort and pain-killers, early ambulation, early return to work; the comfort of the surgery has to be balanced. We think the money spend is a relative term, in relation to the comfort of the patient. It is gratifying to see a major surgery patient nearly pain free, comfortable and smiling immediately after surgery, and asking – ‘have you really done the operation?’, As against, a patient who has a major open surgery and can hardly move in bed due to pain for first few days and later need lots of pain killers to be comfortable.