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Laparoscopic Hysterectomy


 

Definitions:

  • Hysterectomy = removing uterus
  • Salpingectomy = removing tubes

  • Oophorectomy = removing ovaries

  • Bilateral = both sides

 

Hysterectomy is the surgical removal of the uterus. It is often performed for abnormal bleeding or pelvic pain. Removing the uterus is a separate procedure from removing the ovaries. Because the ovaries are left in place, they continue to make hormones, and a person who has their uterus removed does NOT go into instant menopause. They continue to have hormone production, they just no longer have periods. A hysterectomy can be performed through the vagina (total vaginal hysterectomy), through an open incision (laparotomy)--(ex. abdominal hysterectomy) or laparoscopically (through small incisions in the abdomen). The differences between laparoscopic hysterectomy are explained below.

Total Laparoscopic Hysterectomy (TLH) means removing the uterus and cervix using laparoscopy, with the uterus and cervix being removed through the vagina and then the vaginal cuff is closed. It takes 6-8 weeks for the vagina to heal after TLH. During this time, you should not have intercourse, or do strenuous exercise or heavy lifting (>10#). Because the cervix is removed, you no longer have to have pap smears. There is a small risk of an infection or a blood clot forming at the top of the vagina after surgery. There is also a small risk of the vagina separating after surgery, which would need to be repaired surgically, resulting in a prolonged recovery.

  • Pros: No longer have to have Pap smears

  • Cons: 6-8 weeks to heal the vaginal cuff (no intercourse/strenuous exercise/heavy lifting)

    • Small risk of infection or blood clot at top of vagina

    • Small risk of vaginal cuff separation which would require additional surgery

 

Laparoscopic Supracervical Hysterectomy (LSH) is when the uterus is removed laparoscopically. The uterus is detatched from the surrounding tissues, then placed in a bag within the abdominal cavity, then removed through small pieces through one of the small ports (usually in the belly button). The tissue is removed in a completely contained system. The cervix is left in place. Although most uterine fibroids are benign (>99%), there is a rare type of uterine fibroid cancer (leiomyosarcoma). There is not a way to predict who will have this prior to surgery. Because of this, there is a small risk that if leiomyosarcoma is present, additional surgery may be required. It is estimated that the risk of leiomyosarcoma is 1 in 500 in women undergoing surgery for fibroids.

One benefit of LSH is a very quick recovery—usually 2 weeks. There is also a lower risk of surgical complications such as infection or blood clot at the top of the vagina.

Pros:

  • Quicker recovery
  • Lower risk of surgical complications

Cons:

  • 2-3% chance of irregular spotting or staining
  • You need to continue to have pap smears for cervical cancer screening

  • Small risk of needing additional surgery if undiagnosed uterine cancer is discovered

 

Removing Tubes or Ovaries

Bilateral salpingectomy (removing both Fallopian tubes)

Recent studies show that a lot of ovarian cancer actually starts in the tubes. If the tubes are removed at the time of hysterectomy, it lowers the risk of ovarian cancer by 65%. It takes approximately an extra 3-4 minutes in the operating room, without extra recovery. There does not seem to be a benefit to keeping your tubes if you are done having children.

 

Risks vs. Benefits of Removing Ovaries

Benefits:

  • Drastically reduces risk of ovarian cancer 
  • Prevents possible need for future problems with ovarian cysts or pelvic pain, which may require ultrasounds or future surgery

  • Decreased risk of breast cancer if ovaries are removed before menopause

Risks:

  • Increased risk of heart disease and stroke
  • Increased of metabolic syndrome (high blood pressure, pre-diabetes) 

  • Increased risk of death (In general, women die 1-2 years earlier if there ovaries are removed at time of hysterectomy.)

  • Increased risk of memory problems, Parkinson’s symptoms (ex. Tremor), depression, & anxiety