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Hysterectomy is an operation that involves removing the uterus. There are many reasons for hysterectomy including heavy menstrual bleeding, fibroids, endometriosis and prolapse. Hysterectomies have been traditionally carried out through a large abdominal incision (abdominal hysterectomy) or through an incision in the vagina (vaginal hysterectomy). Vaginal hysterectomy avoids an abdominal incision and has a rapid recovery, but only a small proportion of hysterectomies throughout the world are carried out this way. This is because it is usually necessary for there to be good vaginal access, a uterus that is not too enlarged, and no major adhesions. In contrast, it is almost always possible, given the right skills and training to carry out a hysterectomy through "keyhole" or laparoscopic surgery. Pain, length of hospitalization and recovery time is greatly reduced compared with abdominal hysterectomy
Total laparoscopic hysterectomy In a total laparoscopic hysterectomy the uterus, including the cervix is removed. 4 keyhole incisions are made in the abdomen and laparoscopic instruments used to peform the operation. Keys steps in the operation are:
A total laparoscopic hysterectomy takes 1-2 hours and you are in moderate discomfort for the first 24 hours. Strong pain killers are often required during this time. However the pain rapidly subsides and you are usually discharged from hospital about 48 hours after the operation.
The length of time for you to return to normal activities will vary according to a number of factors such as your age, fitness, and the difficulty of the operation. After two weeks most patients are able to carry out normal activities, apart from stenuous extertion or heavy manual work. This compares to abdominal hysterectomy where the length of recovery is usually about six weeks. Because of the precision of laparoscopic surgery there is also less blood loss and less chance of infection.
Laparoscopic supracervical hysterectomy involves the same keyhole surgery as for laparoscopic total hysterectomy. However, while the body of the uterus is removed, the cervix is retained. The uterus is divided above the cervix, and the vagina is not opened. The body of the uterus is then extracted through one of the keyhole incisions using a special device called a morcellator.