By Hysterectomy, we mean the removal of the uterus. Commonly it involves the removal of uterus and cervix, which is called Total hysterectomy. Many a time it is combined with removal of both fallopian tubes and ovaries ( bilateral salpingo-oophorectomy). When done in cancer patients which involve removal of uterus, cervix, both fallopian tubes, ovaries and surrounding connective tissues called parametrium, It is called Radical hysterectomy.
Hysterectomy is advised in women in whom medical or conservative treatment has failed to treat abnormal uterine bleeding, symptomatic fibroids or endometriosis.
Other indications are uterine prolapse and cancer of the uterus, ovaries or cervix.
Hysterectomy can be performed by the open method or done laparoscopically. Now commonly the laparoscopic method is preferred and it has become the choice unless there is a specific contraindication for laparoscopic surgery.
Laparoscopy is called minimally invasive surgery or key hole surgery as it involves less damage to tissues and the abdominal skin incisions are very small.
Laparoscopic hysterectomy involves inserting a camera through a 1.0 cm incision in abdominal wall and other instruments through 0.5cm incision ports.
Hysterectomy done through laparoscopy has many advantages compared to open method.They are
- Less chance of infection
- Less chance of postoperative pain
- Shorter hospital stay
- Faster recovery
- Sooner return to regular routine
- Cosmetically it involves smaller incisions of 5mm to 1.0cm compared to 10 to 13cm in open method
As in any other surgery, Laparoscopic surgery has attendent risks, there could be risks of infection, bleeding requiring blood transfusions, damage to urinary bladder or intestines or to ureters and if such chances happen, there is a possibility of conversion to laparotomy( open surgery).