Total Laparoscopic Hysterectomy(TLH)

TLH is total laparoscopic removal of the uterus and cervix. The Fallopian tubes are also usually removed. The ovary is removed only if needed. This surgery is done only in those women who have completed their family and are not desirous of future childbearing.

Usually four incisions are made in the abdomen: one-centimeter at or above the navel (belly button) and three half centimeter ones on the sides. The abdominal cavity is then filled with carbon dioxide gas. A thin, lighted telescope, called a laparoscope, is placed through the incision, allowing doctors to see the ovaries, fallopian tubes and uterus as well as other pelvic structures. The surgeon performs the hysterectomy viewing the operation on a video screen. Because of better visualization and magnification, this surgery is more precise and accurate than open hysterectomy. A traditional open hysterectomy requires an abdominal incision of five to eight inches which can lead to significant discomfort in the postoperative period along with limitataion of activity.

A woman may need a hysterectomy for different reasons, including:

• Uterine fibroids that cause pain, bleeding, or other problems
• Uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal and somtimes even protruding ouside the body
• Endometriosis
• Abnormal vaginal bleeding
• Chronic pelvic pain
• Adenomyosis
• Cancer of the uterus or cervix

Post surgiery, patients have a much quicker recovery, usually going home after 1 day in the hospital. They can return to their normal routine in one to two weeks. Patients report less pain, minimal post-surgical narcotic pain medication use, and a faster recovery time than women undergoing abdominal(open) hysterectomies. 

Laparoscopic Supracervical Hysterectomy (also called Subtotal Hysterectomy): Removes the uterus but leaves the cervix in place. Some research suggest that leaving behind the cervix may reduce the risk of pelvic organ prolapse and better preserve sexual function. However the high incidence of cervical cancer in India has to be taken into consideration while taking a decision for subtotal hysterectomy. 

Laparoscopic Radical Hysterectomy: This is a more radical surgery removing all of these organs- the uterus, cervix, fallopian tubes, ovaries along with the parametria(the connective tissue adjacent to the uterus and cervix) plus the pelvic lymph nodes. This is performed in case of cancer of the uterus and cervix.

Advantages of Laparoscopic Hysterectomy 

• Lesser Blood Loss
• Lower Post Operative pain
• No vaginal shortening
• Shorter Stay at Hospital.
• Lesser abdominal wall infections as compared to abdominal hysterectomy.
• Fast Recovery from surgery wounds.
• Less chances of incisional hernia
• Cosmetically better as small scars

Even a large uterus can be removed laparoscopically. Women who have had multiple pelvic and abdominal surgeries can also have TLH . In fact these cases benefit the most from a laparoscopic approach. Many such cases are referred to us by our colleagues and it is gratifying see these patients doing so well after successsful laparoscopic surgery.

This surgery should be performed only by an expert and experienced surgeon. Just because it is a laparoscopic surgery does not mean it is a minor surgery.