Minimally Invasive Hysterectomy

A hysterectomy is a surgical procedure to remove the uterus. Historically, hysterectomies have been performed either by making an incision in the abdomen (either a "bikini" incision or a vertical incision between the belly button and the pubic bone) or, if the uterus is not too large, an incision in the top of the vagina-a vaginal hysterectomy. When an incision is made in the abdomen, not only the skin but many other layers need to be cut and to heal.

This produces a significant amount of post-operative pain and recovery time. It is actually the healing of the skin and other layers beneath it that accounts for most of the pain women experience after a hysterectomy, not the actual removal of the uterus.

When is Hysterectomy done?

• Certain types of reproductive system cancers (uterine, cervical, ovarian, endometrium) or tumors, including uterine fibroids that do not respond to more conservative treatment options.

• Severe and intractable endometriosis (growth of the uterine lining outside the uterine cavity) and/or adenomyosis (a form of endometriosis, where the uterine lining has grown into and sometimes through the uterine wall musculature), after pharmaceutical or other surgical options have been exhausted.

Chronic pelvic pain, after pharmaceutical or other surgical options have been exhausted.

• Postpartum to remove either a severe case of placenta praevia (a placenta that has either formed over or inside the birth canal) or placenta percreta (a placenta that has grown into and through the wall of the uterus to attach itself to other organs), as well as a last resort in case of excessive obstetrical haemorrhage.

• Several forms of vaginal prolapse

Hysterectomy Surgery is most often performed for the following reasons:

• Uterine Fibroids: : Are the common, benign (non cancerous) tumors that grow in the muscle of the uterus. More hysterectomies are done because of fibroids than any other problem of the uterus. Sometimes fibroids cause heavy bleeding or pain.

• Endometriosis: Is another benign condition that affects the uterus. It is the second leading reason for hysterectomies. It occurs when endometrial tissue (the inside lining of the uterus) begins to grow on the outside of the uterus and on nearby organs. This condition may cause painful menstrual periods, abnormal vaginal bleeding and loss of fertility.

• Uterine prolapse: : Is a benign condition in which the uterus moves from its usual place down into the vagina. Uterine prolapse is due to weak and stretched pelvic ligaments and tissues, and can lead to urinary problems, pelvic pressure or difficulty with bowl movements. Childbirth, obesity and loss of estrogen after menopause may contribute to this problem.

• Cancer: is the reason for about 10 percent of all hysterectomies. Endometrial cancer, uterine sarcoma, cervical cancer, and cancer of the ovaries or fallopian tubes often require hysterectomy. Depending on the type and extent of cancer, other kinds of treatment such as radiation or hormonal therapy may be used as well.

• Hyperplasia: Is believed to come from too much estrogen and occurs when the lining of the uterus becomes too thick and causes abnormal bleeding.

In this procedure along with the removal of the uterus, ovaries, fallopian tubes, cervix, upper vagina, connective tissue surrounding the uterus and the nearby lymph nodes are also removed. This generally indicated in cancers of the uterus.

• Radical Hysterectomy-

• Total Hysterectomy- In this procedure the entire uterus along with the cervix is removed. The other organs are left intact.

• Subtotal Hysterectomy- In this procedure only the body of the uterus is removed. The cervix is kept in place.

Abdominal Hysterectomy - is the oldest techniques in which the uterus is accessed through a horizontal or vertical incision of 5"-7" made in the lower part of the abdomen (just above the pubic line). This procedure is generally used for radical hysterectomy as the entire reproductive complex can be viewed and explored through this incision. Since this procedure involves the cutting of abdominal muscles, recovery after this surgery is slow to allow healing of the muscles. It generally takes 6 months for complete recovery.

2. Vaginal hysterectomyAn incision is made at the top of the vagina, through which the uterus, including the cervix, is separated from surrounding tissue and then taken out through the vagina. This small vaginal incision heals quickly and usually won’t leave an external scar. There is little discomfort since the abdominal muscles are not stretched during the procedure. It takes one to two hours and requires a hospital stay of about one to three days. The recovery will usually take about four weeks.

3. Laparoscopic Approaches

• Total laparoscopic hysterectomy (TLH). This procedure involves removing the entire uterus, including the cervix, through the vagina. The top of the vaginal opening inside the abdomen is then sewn together using instruments inserted through a laparoscope.

• Laparoscope-assisted vaginal hysterectomy. In this operation, the surgeon inserts a laparoscope through the abdomen to inspect the upper abdomen extensively during the procedure. A surgeon might opt for this approach if the patient has pelvic adhesive disease that may have rendered a straightforward vaginal approach unsafe. This technique also may be preferred if the surgeon plans to remove the ovaries. During the procedure, the surgeon uses port access to disconnect the uterus and other structures, which then are removed through the vagina.

• Laparoscopic supracervical hysterectomy (LSH). This less-invasive approach is preferred by surgeons who believe it may be associated with a decrease in future incidence of vaginal prolapse. The surgeon detaches the uterus from the cervix but leaves the cervix and its fibrous support structures intact. The uterus is cut into small strips, which then are pulled out through ports.