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Hysterectomy is the removal of the Uterus, with or without the surrounding organs for diseases like Uterine Fibroids, Endometriosis, Uterine Cancer. This is considered as a treatment option only when the woman no longer wishes to have children or has crossed child bearing age and when other treatment modalities fail.
Hysterectomy is most commonly performed in a hormone related condition, where there is thickening of the endometrium resulting in dysfunctional uterine bleeding.
Other ailments that warrant removal of uterus or hysterectomy are :
Non-life threatening growths in or around the womb that cause painful periods, persistent pain and discomfort during sexual intercourse.
Growth of uterine tissues on other organs of the reproductive tract or within the muscles of the womb causing irregular periods, abdominal pain and difficulty getting pregnant.
When cancer affecting the female reproductive tract reaches advanced stage, hysterectomy is considered.
Removal of the uterus and related structures is called a hysterectomy.
Based on the nature of disease that warranted hysterectomy, the surgeon may decide to remove just the uterus, or the uterus and associated reproductive organs. At times, like in the case of uterine cancer, it may be necessary to remove all organs in the vicinity of the uterus.
A hysterectomy usually consists of one or both of the following actions:
- Use a laparoscope to dislodge the uterus from the abdomen
- Remove the dislodged uterus through vagina or keyholes made for laparoscopic entry.
Based on the nature of ailment and patient requirements, the surgeon choses a particular flavor of hysterectomy
Variations of Hysterectomy
LAVH: Laparoscopically Assisted Vaginal Hysterectomy
Laparoscopic instruments are inserted through a single keyhole incision made in the abdomen. Laparoscope is inserted through this incision, which helps in real time viewing of the reproductive organs and other internal structures. Surgical instruments are inserted through the vagina and using video guidance, the uterus and other reproductive organs are separated from their attachments. The organs are then removed through the birth canal.
Total Laparoscopic Hysterectomy
A keyhole incision is made in the abdomen through which laparoscopic instruments are inserted. The structures carrying the urine(ureters) are identified and separated. Blood vessels supplying the womb are tied up through instruments inserted into the abdominal incisions. The reproductive organ is then removed in tiny portions either through the abdomen or through the birth canal.
Laparoscopic Supracervical Hysterectomy
This is similar to TLH but in this case the lower part of the uterus which connects the uterus to the birth canal is not removed. Through a single hole in the belly button (if the patient opts for scar less procedure) and 2 or 3 holes (if its a laparoscopic procedure), the ligaments that attach the uterus to the walls of the pelvis are carefully cut and released. The arteries supplying blood to the uterus are also interrupted by burning, tying or clipping them off.
This procedure is done laparoscopically for advanced cancers found in the female reproductive tract. In this procedure lymph nodes, the womb and structures surrounding it are also removed.
In case of cancers it is best to get the uterus removed before it is too late. If the cancer spreads to other sites then it can be fatal.
In other conditions if the family is complete and there are no plans of giving birth to a child then the uterus is best to be removed.
Life after LAPAROSCOPIC HYSTERECTOMY
- Avoid lifting heavy things.
- To take plenty of rest.
- Avoid sexual relations for 6 weeks.
- Keep the wound clean and healthy.
Video: lap sils hysterectomy
If you have multiple fibroids and you are having severe symptoms, like bleeding every month and pain during periods, then you should consider strongly having a hysterectomy. On the other hand, you have only one fibroid, you can have only a Myomectomy, the removal of the fibroid alone.
If your fibroid is not symptomatic, and your nearing menopause, it might be worth it to just wait for a year or two, and it is quite likely that the fibroid will not grow any larger. And the other hand it is very symptomatic, with a lot of blood loss in every menstrual periods, you might well be advised to have some treatment for the same.
You could have embolisation of the uterine artery, in which we cut off the blood supply to the fibroids by passing small catheters into your blood vessels, and this often helps to shrink the fibroids completely. However this is not always successful.
Yes of course, laparoscopic hysterectomy or keyhole hysterectomy is probably the best way to have a hysterectomy as it is bloodless, involves much less pain, has you back on your feet quickly, and avoids all the complication of an open surgery like adhesions, hernia, etc. In other words it is the very best way to have a hysterectomy.
Although when probably done, it is a perfect way of having the surgery, there could sometimes be an injury to the bladder or the ureter in the process of performance of a hysterectomy. This is why it is a procedure that requires a little training before it is under taken. In case the ureter or the bladders are injured, this will have to be dealt by the urologist immediately or within a few weeks.
No. You will take probably a day or two to go home but by the time you go home you will be quite fit and ready to get back to your normal work.
No, not really, for a day or two after hysterectomy some women need to have the catheter in place. But very rarely does one need to keep a catheter for extended periods of time. Indeed these days we remove the catheter even at the end of the surgery, so that you are free of tubes and catheters in the post operative period.
No. It is only as expensive as an open hysterectomy, and in the long term it costs far less in terms of pain, discomfort and complications.
Laparoscopic Hysterectomy Surgeons
Dr. J. S. Rajkumar
M.S., F.I.C.S., Dip. N.B. (SURG.), F.R.C.S. (ENG.), F.R.C.S. (EDIN.), F.R.C.S. (GLASGOW), F.R.C.S. (IRELAND), F.I.M.S., F.A.I.S., F.R.M.S. (LONDON), F.A.E. (GASTRO), F.A.C.G. (USA), F.I.C.A. (USA), F.I.A.G.E.S., Dip M.I.S. (FR.)
Dr. Deepa Ganesh
Advance Laparoscopic Gynecologist, Robotic Surgeon & Cosmetic Gynecologist Surgeon
Obstetrician and gynaecologist, Infertility specialist and Laparoscopic surgeon