It is the removal of uterus (womb) by use of laparoscopic instruments for various uterine pathologies not responding to medical line (pills).
Abnormal uterine bleeding (AUB) – Usually women face these gynecological problems during their reproductive age group. The standard line of therapy involves use of pills to control excessive bleeding like Tranexic acid, Ormiloxafene, oral hormonal pills. If the symptoms recur after stoppage of course of pills or there is no response, they can evaluated for hormone releasing special intrauterine device (like CuT). If they do not respond to any of these therapies, you will be suggested to undergo uterus removal surgery (Hysterectomy)
- Postmenopausal bleeding – Following menopause, vaginal bleeding is an indication for further evaluation to rule out polyps, fibroids, uterine cancer
- Symptomatic fibroids, large fibroids
- Uterine, Cervical cancer
- Genital prolapse
- Pelvic inflammatory disease, pills not able to relieve symptoms
- Adenomyosis, Endometriosis
There are various methods for removal of uterus. Abdominal (large skin cut of 10-12cms is given over tummy to remove the uterus), Vaginal (uterus is removed by vaginal route, preferred when uterine prolapse is there but difficult when adhesions and pelvic masses are there), Laparoscopic (small incisions of 5 – 10mm are made over tummy and camera, instruments are inserted to do hysterectomy), Robotic (use of robot to to control instruments when the surgeon sits on a chair comfortably and gives commands).
Once the surgery is planned, few blood tests, x-ray, ECG and ultrasound are done. On the day of surgery, admission is done. You will be given general anesthesia and the surgery begins with creation of ports (3/4 no’s) and instruments like bipolar/monopolar current will be used to avoid excess blood loss. In certain situations, special instruments like Harmonic scalpel, Ligasure may be used. Following removal of uterus with or without removal of fallopian tubes and ovaries and vault is sutured with self absorbing thread. Self absorbable skin stitch for 10 mm port.
The next day of surgery, urine catheter is removed and water and soft food can be taken. Once the patient passes urine comfortably and tolerates food, she will be fit for discharge. Water proof dressing is done which will be removed after 7 days during checkup. Re-evaluation after 6 weeks of surgery to confirm vault healing is important.
The complications with laparoscopic surgery are least with experienced hands. This is the reason for increase in the preference of laparoscopy over other methods of hysterectomy. There may be vaginal bleeding in some which is normal upto 6 weeks following surgery if it is minimal quantity and not increasing day by day. The advantages of laparoscopic hysterectomy are-
- Less blood loss hence, less chances of blood transfusion
- Small, cosmetic scars with no stitches
- Rapid recovery hence, short duration of hospital stay
- Minimal post surgery pain hence, less pills are needed
- Less adhesions hence, less chances of post surgery complications
- Rapid return to day today activities and work