Laparoscopic hysterectomy

A laparoscopic hysterectomy is an operation to remove the uterus (womb) through keyhole incisions. We consider this procedure for the treatment of the following conditions:

• Uterine fibroids
• Period problems, such as heavy or painful periods
• Severe endometriosis
• Suspected cancer of the womb or cervix

There are three types of laparoscopic hysterectomy:

• Total Laparoscopic Hysterectomy (TLH): the body of the uterus and cervix (neck of the womb) are removed
• Subtotal Laparoscopic Hysterectomy (SLH): the body of the uterus is removed but not the cervix
• Laparoscopic Assisted Vaginal Hysterectomy (LAVH): an operation partially carried out via laparoscope and the rest vaginally

The type of hysterectomy will depend on individual circumstances and will be thoroughly discussed with the patient before the operation.

Sometimes ovaries and tubes are removed at the same time; this is called a salpingo-oophorectomy. If only the tube is removed this is called salpingectomy.

The procedure is performed under a general anaesthetic through three or four keyhole incisions that are 0.5 to 1 cm long. Special surgical instruments are used to remove the womb from the ligaments that hold it in place and also to tie up the blood supply. The uterus is removed through the vagina in the case of TLH and LAVH. In SLH a morcellator (a device which breaks up the tissue into small pieces) is used to enable the uterus to be removed through a 10mm incision. The operation normally takes around 60–90 mins to complete.

Most women stay in hospital for one to two days after surgery. Usually, on the first morning after the operation the catheter is removed and the patient is able to eat, drink and move around.

Recovery after surgery varies between individuals. The body will be using extra energy to build new cells and repair itself and patients may therefore feel tired for six weeks after surgery. Most women will resume driving and work within four weeks.