laparoscopic hysterectomy

Laparoscopic hysterectomy was introduced to make it possible to remove the uterus without laparotomy when vaginal hysterectomy was considered to be impossible. For instance, if you have a history of endometriosis, significant pelvic adhesions or an ovarian cyst, then laparoscopic hysterectomy can be considered. If there is uncertainty as to whether vaginal hysterectomy is feasible or not, laparoscopy at the start of hysterectomy can help determine the optimal route of surgery . In contrast, there are situations where abdominal hysterectomy is the only realistic option, such as if you have large fibroids.

There are several types of laparoscopic hysterectomy depending on what proportion of the surgery is done laparoscopically, and what proportion is done vaginally as in most cases the uterus is in fact removed via the vagina. At one end of the spectrum, a laparoscopy is done for diagnostic purposes, and if no significant pathology is found, a vaginal hysterectomy is done without any laparoscopic surgery as such. At the other end of the spectrum, the hysterectomy is done purely laparoscopically with no vaginal surgery at all. Most gynaecologists practise the intermediate procedure of what is called "laparoscopically assisted vaginal hysterectomy", that is, some of the surgery is done laparoscopically and some vaginally.

The major advantage of laparoscopic hysterectomy over abdominal hysterectomy is that your recovery will be faster, much more like the situation after vaginal hysterectomy. The major disadvantage of laparoscopic hysterectomy is that major complications are more likely, particularly in terms of major haemorrhage and bladder injury.