Total Laparoscopic Hysterectomy
Hysterectomy – surgical removal of the uterus – scares women. Ever since the first successful Abdominal Hysterectomy (AH) in 1853, hysterectomy was associated with big cut and scar, pain, days of hospitalisation and weeks of convalescence. These were much lessened with the advent of Laparoscopic Hysterectomy (LH) in 1988. But old memories die hard.
Hysterectomy is the most common gynaecological surgery after Caesarean section.
LH and AH are well-established procedures now. Out of the five ways of doing the hysterectomy, Total Laparoscopic Hysterectomy (TLH), developed in the 1990s, is the latest, and the best. But it needs a well-trained, experienced and highly skilled surgeon to perform it.
TLH is surgical removal of uterus and cervix, and, for some conditions, the fallopian tubes, ovaries and other surrounding structures, using a laparoscope.
TLH is the best procedure because it offers superior visualization of pelvic anatomy and substantial and dynamic access to the uterine vessels, vagina, and rectum from many angles. And because its success rate is high, above 90%; complications are rare; short-term morbidity (blood loss, wound infections, and postoperative pain) is lesser; hospital stay is shorter; resumption of normal activities is faster; and conversion to laparotomy, that is to AH, is low (2-3%).
TLH operation time is longer than other hysterectomy procedures. Operating time can be reduced by using uterine morcellation which also reduces the intraoperative complications. An experienced surgeon can complete a simple TLH in about 80 minutes; and a complex case in about 190 minutes.
Direct cost for TLH is higher than for Abdominal Hysterectomy (AH), but the total cost of the two procedures is about the same because of the shorter hospital stay and lesser morbidity in TLH.
Just like any other surgical procedure, TLH also carries certain risks. The main risks are: injury to nearby organs (bladder or urethra) especially if the surgeon is not highly skilled; anesthesia problems such as breathing or heart problems; blood clots in the legs or lungs; infection, heavy bleeding, urinary complaints; early menopause if the ovaries are also removed; and pain during sexual intercourse.
A few problems that may occur later are backache, weakness, pain, vaginal discharge, incontinence, gas, difficulty in sitting and walking, and weight gain. A few women may feel a ‘sense of incompleteness.’
TLH can be done on any patient with benign gynecologic diseases. The only limitations are the surgeon’s experience and the patient’s pelvic anatomy. A surgeon with insufficient knowledge or training in laparoscopy is likely to abandon a TLH.
Laparoscopy may not be possible in patients with a pelvis with severe adhesive disease, obstructive leiomyomata, or any other anatomic limitation that prevents safe entry into, or inadequate working space in, the abdomen. Patients who have a history of repeated cesarean sections or multiple laparotomies or midline incisions gain more than 50% possibility of having organ adhesion in the umbilical area and thus may not be suitable for obtaining TLH surgery.
Patients who pass through elevated Body Mass Index, the uterine width get larger than 10 cm, lateral or lower uterine segment fibroids which are of more than 5 cm length, and previous adhesion-forming abdominopelvic surgery – are at a higher risk of TLH being converted to laparotomy.
Hysterectomy is the only treatment for cervical, uterine, or ovarian cancer. And maybe needed when treatments alternative to hysterectomy in the following conditions do not work: Fibroids with symptoms, Endometriosis, Prolapse, Cervical Dysplasia, Abnormal vaginal Bleeding, Heavy periods, Pelvic inflammatory disease (PID), Chronic pelvic pain, Adenomyosis. Emergency hysterectomy may be necessary in cases of uncontrolled uterine haemorrhage or infection.
Prevalence of hysterectomies rises with age. More hysterectomies are in women above age 35, and the maximum is in women age 45-54. In India, women give precedence to family commitments above their own health. So they often postpone hysterectomy till the family is complete, or children have grown up.
Hysterectomy is a nearly 160-year-old procedure. First Abdominal Hysterectomy (AH) was done in 1843, but the patient died. First successful AH was in 1853. First total AH (TAH) was in 1929. First laparoscopic hysterectomy was in 1988. Dr. Prabhat K developed Total Laparoscopic hysterectomy in the early 90s. Ahluwalia in Upstate New York. The first series of successful robotic laparoscopic hysterectomies was in 2002.
Future lies in robotic Surgeries. Its cost is high at present but will reduce significantly over the next few decades.
About 70% of hysterectomies are not medically necessary, and you cannot have a child after hysterectomy. So Best Gynae Laparoscopic Surgeon in Delhi about alternatives; and take a second and a third opinion.
All gynec surgeries can now be done with a laparoscope. But just because it can be done, does not mean it should be done.
So, go by the advice of Best Gynae Laparoscopic Surgeon in Delhi. She weighs several factors and options to decide which surgery, laparoscopic or open, is best suited in your specific case.
Best Gynae Laparoscopic Surgeon in Delhi
“There are only a few contemporary newly trained gynecologists who have sufficient experience and confidence to carry on the complicated procedure of TLH, and they have the highest level of surgical skills.”
– Johnson N et al, Scientific Study in the US, 2005.
Lap-surgery is a non-intuitive motor knowledge which is not that easy to learn. The surgeon has to strive harder to gain knowledge about this technology and attain master in TLH. The success of surgery has “significant and positive correlation with surgeon experience.” And though “Quantity alone is not a guarantee of quality, it is an indication of competency”.
I’m a laparoscopic surgeon in Delhi for 25 + years; done 3,000 + lap-surgeries; and do about 200 + every year.