Total Laparoscopic Hysterectomy

The less technical difficulty, less trauma, and a shorter operating time have all been linked to laparoscopic hysterectomy (LH). There is a small risk of cervical cancer if the cervix is retained, and a small percentage of these women continue to experience cyclical bleeding beyond menopause. According to a retrospective study, the cervical stump is the site of origin for 2% of all cases of cervical cancer. At 5 years of follow-up, a prospective cohort study of 70 patients receiving LH mostly for endometriosis and pelvic pain discovered that 23% needed additional surgical treatment due to persistent vaginal bleeding or pelvic pain. Additionally, compared to laparoscopic hysterectomy, an open hysterectomy had greater readmission rates, according to a prospective, randomized trial. There were no significant statistical differences in complications, symptom alleviation, or activity limits in this small study. Sexual function, urinary tract symptoms, and bowel symptoms were not significantly different between total and subtotal abdominal hysterectomies in three randomized, controlled trials. Among patients who underwent a total and subtotal hysterectomy, a recent study with a mean follow-up of 9 years found no significant differences in the incidence of pelvic organ prolapse or other outcomes.

What is Laparoscopic Hysterectomy

Under general anesthesia, a laparoscopic hysterectomy is a keyhole procedure used to remove the womb (uterus). To treat or relieve a variety of gynecological issues, it is a popular surgical treatment that may also involve the removal of the fallopian tubes, ovaries, and cervix.

Other Types of Laparoscopic Hysterectomy

Other laparoscopic hysterectomy procedures include:

When the uterus is removed but the cervix is still present, this procedure is known as a subtotal or supracervical hysterectomy.
Additionally, you could have a bilateral salpingo-oophorectomy (BSO) along with the above treatment. One or both of your ovaries and fallopian tubes will be removed during this procedure.
Total laparoscopic radical hysterectomy. This procedure involves removing the entire womb, cervix, ovaries, fallopian tubes, a portion of the vagina, and some lymph glands. Cancer is the reason for this procedure.

Laparoscopic Hysterectomy Indications

Unless it is performed as a life-saving procedure for illnesses like cancer, a laparoscopic hysterectomy is often only performed as a last resort after all other treatments have failed. You and your doctor should talk before choosing to get a hysterectomy. When other therapies have failed or there are no other options, a laparoscopic hysterectomy is typically required to cure either acute or persistent painful and distressing symptoms. Having this surgery will help you live a healthier lifestyle and resolve these issues. The following are a few causes for a laparoscopic hysterectomy:

Heavy menses or excruciating menstruation pain. Some women whose quality of life is unreasonably affected by heavy or extremely painful periods will benefit from undergoing a laparoscopic hysterectomy after all other therapeutic options have been tried. Heavy bleeding may occasionally result in anemia.
Fibroids. Any area of the body with smooth muscle can develop fibroids, which are solid benign (non-cancerous) tumors or growths. The uterus's muscular wall is one of the sites where it can grow most frequently. Fibroids are frequent and don't always cause issues; they can vary in size, number, and position within the uterus. However, they can lead to painfully heavy periods in certain women. Large fibroids may push on the bladder and result in symptoms related to the urinary system.
Endometriosis. The uterine lining, or endometrium, sheds each month to cause menstruation. Endometriosis develops when the lining of the uterus is discovered elsewhere in the body, frequently on the ovaries, fallopian tubes, and other nearby organs like the bladder or colon. This lining is not attached to the uterus, thus menstrual blood from it cannot escape and may be painful. They might also make the bladder or rectum stick to the uterus or fallopian tubes and result in scarring around the womb. Painful periods, abdominal pain, or pain during sex can all be symptoms of endometriosis.
Adenomyosis. Adenomyosis is a very frequent disorder in which the lining of the uterus invades the muscle wall of the womb, having many of the same symptoms as endometriosis.
Cancer. A laparoscopic hysterectomy may be recommended if you are diagnosed with uterine cancer. You can get further information on cancer treatment from your doctor.

What Happens Before Laparoscopic Hysterectomy

The nurse will go over your hospital stay and your procedure at your pre-op evaluation and on the day of your admittance. If you have any worries or believe there are information doctors should be aware of that would make your stay with them more pleasant.

Before entering the hospital and throughout your recovery, you will need to establish plans for your loved ones, your kids, or any other responsibilities you have. Before you enter the operating room, you will see the surgeon doing the procedure and the anesthesiologist. It is common to experience anxiety; the nursing team will be happy to talk with you about how you are feeling and help you work through your feelings.

Laparoscopic Hysterectomy Procedure

Because it is carried out through tiny incisions created in the abdomen, a laparoscopic hysterectomy is also known as keyhole surgery. Through the incisions, specialized surgical tools are inserted, and the procedure is carried out with the aid of an inside telescope and camera system. Other tissues, occasionally including lymph nodes, may also be removed through the vagina or tiny incisions in the abdomen. The uterus is removed through the vagina. There will be two to four little scars on various places on your belly. The length of each scar will range from 0.5 to 1 cm. If your cervix was removed, you will also have an unnoticeable scar at the top of your vagina. A laparoscopic hysterectomy requires only one night of hospitalization.

What Happens After Laparoscopic Hysterectomy

You can have periods of pain and/or nausea as you recover from the anesthetic. Inform the nursing personnel so they can evaluate you and take the proper measures.

Your nurse will monitor the laparoscopic incisions, any vaginal bleeding, and your blood pressure, pulse, breathing, and temperature. When you are able, they will ask you to move from side to side and perform breathing and leg exercises to help prevent chest infections, deep vein thrombosis (DVT), and other pressure-related problems.

You will have an intravenous infusion drip attached, and after you are completely awake, you can begin drinking and eating. Then your drip will be stopped.

For the first few days following the procedure, you should expect pain and discomfort in your lower abdomen. The gas and water utilized through the telescope, which may become trapped under your rib cage during laparoscopic surgery, may also cause shoulder tip pain. To aid with this, painkillers will be given to you.

Early mobilization will be encouraged and supported by the nursing team. When you return to the ward, they often anticipate that you will sit up in bed and start to move around. Additionally, a catheter that drains your urine will be connected to you. The nursing team will remove this the following morning. The catheter will be removed and then you have to empty two urine samples and check your urine flow to make sure you are emptying your bladder appropriately. After you have urinated, doctors could scan your bladder to make sure it is emptying properly.

You will have 2-4 little dressings on your abdominal cuts. You can take a shower and take care of your hygiene needs with these waterproof items. The nursing staff will give you a blood-thinning injection following surgery to assist prevent a DVT. The gynecologist will let you know if you need to do this yourself at home if it applies to you.

The discomfort of trapped wind may be felt; peppermint water and standing up and moving around will relieve it. Doctors will give you modest laxatives to soften your stools and avoid constipation and straining if you first have trouble opening your bowels.

Laparoscopic Hysterectomy Recovery

The gynecology team will check on your progress the next day, evaluate you, and make decisions about your care that will be disclosed to you. Then you will be able to return home. Feel free to inquire at any time about your procedure or recovery.

After a laparoscopic hysterectomy, the typical stay is one day. Your convalescence will be discussed by the nursing staff while you physically recover from your procedure. You should be aware of the following to ensure a speedy recovery:

Rest

It's normal to feel worn out, exhausted, and upset during the first two weeks at home. You should take it easy during the day and progressively do more each day. When lying down, keep your legs from crossing.

Vaginal Bleeding

After surgery, you should anticipate having some vaginal discharge or bleeding for one to two weeks. This has a reddish or brown color and resembles a light period. After around 10 days, some women experience an unexpected gush of blood; this is extremely usual and should pass quickly. To lessen the risk of infection, sanitary towels should be used instead of tampons.

Stitches

Your incisions will first have a dressing on them. Remove within 48 hours. Stitches, which are often removable, will be used to close your wound. The stitches must be removed if, after 7 days, you detect they haven't fallen out. You will need to schedule an appointment, and your practice nurse will typically perform this. Doctors suggest taking a shower every day and keeping the wound clean and dry. There is no obligation to dress the wound.

Preventing DVT

Your chance of developing deep vein thrombosis (DVT) after any operation is low. The lungs (pulmonary embolism) may be affected by these clots which is a serious matter. Lower the risks by:

Being mobile
Leg movements
Blood-thinning drugs
compression stockings

You will discuss these with your doctor before leaving the hospital.

Housework

Doctors advise you to perform light housework in the first and second weeks and to refrain from heavy lifting (not more than 1.5kgs in each hand). They advise you to gradually incorporate lighter domestic activities, such as dusting, washing dishes, making beds, and ironing, in the third and fourth weeks. You can start cooking and preparing food but be careful not to lift anything heavy. You should start back up with your regular daily activities by the fifth week.

Exercise

Exercise is important; thus, it's advised to take daily, short walks with an increase in distance. After 4-6 weeks, you can resume regular exercise like cycling and swimming. When you get home, you will be able to complete the stairs.

Diet

Constipation can be prevented with a diet that is highly fiber-rich, well-balanced, and nutritious. After surgery, it could take some time for your bowels to function normally, and you might need to take laxatives. At least five pieces of fruit and vegetables each day are recommended. At least 2 liters of water each day should be your goal.

Returning to Work

You will require two to six weeks off work, depending on the procedure. Discuss this with the doctor or nurse; most women can resume their jobs after two to three weeks. A sick note for this period will be provided by the hospital's physician.

Driving

After three to six weeks, you can normally resume driving, but it will depend on your level of focus, your ability to make an emergency stop, and whether your car insurance provider accepts.

Laparoscopic Hysterectomy Risks

Any operation carries some risk, but it's a small one. The following are the primary risks of a laparoscopic hysterectomy:

Postoperative discomfort, especially at the shoulder tip
Infection, frequency, and retention of the urine
Bruising, infection, and a delay in the healing of the wound.
An injury to the bladder
Injuries to the bowel
Pelvic infection or an abscess
Pulmonary embolism and venous thrombosis (clot in lung or leg)
Inability to enter the abdominal cavity and finish the procedure
Hernia at the entry site
Bleeding that needs blood transfusions
Return to the theater due to the bleeding
Unplanned laparotomy
Vaginal vault dehiscence (opening) requiring re-suturing.

Ask a doctor or nurse if you have any questions regarding the procedure before signing the permission form so that you may make an informed decision about your surgery.

Conclusion

Hysterectomy (surgical removal of the uterus) was first successfully performed in the 19th century using vaginal or abdominal incisions. Innovations in technology led to the performance of the first laparoscopic hysterectomy in 1989. According to United States national surveillance data, the laparoscopic mode of access has become the most common approach to hysterectomy, with a shift toward outpatient procedures. Additionally, laparoscopic surgery can be performed with conventional laparoscopic instruments or with computer assistance using robotic equipment and instruments.