Laparoscopic, abdominal and vaginal hysterectomy

Laparoscopic, Abdominal & Vaginal Hysterectomy

What is a Hysterectomy?

A Hysterectomy involves the removal of the uterus (womb). A Hysterectomy may be recommended as a treatment for:

Heavy Periods
Irregular Periods
Painful Periods (endometriosis, adenomyosis)
Fibroids
Uterine Prolapse
Uterine or ovarian cancer

What are the Types of Hysterectomy?

There are two types of hysterectomy:

Total Hysterectomy where the uterus and the cervix is removed
Subtotal Hysterectomy where the uterus is removed but the cervix is left behind

Hysterectomy can be performed through the vagina, called a vaginal hysterectomy, through an incision into the abdomen, called an Abdominal Hysterectomy or by using a laparoscope called a laparoscopic hysterectomy.

We recommend that the Fallopian tubes are removed (Salpingectomy) at the time of hysterectomy where possible as it lowers the risk of ovarian cancer. Removing the tubes does not affect your hormone levels.

Sometimes the ovaries are also removed (oophorectomy) as it will reduce the risk of ovarian cancer. We recommend oophorectomy for all women older than 60 and in younger women if there is any indication.

What are the Possible Risks Of Hysterectomy?

As with any surgical procedure, there are associated risks and complications which include:

Anaesthetic complications
Bleeding
Infection
Deep vein thrombosis
Injury to other internal organs - 1/200 risk of inadvertent damage to bladder, bowel or ureter
Any specific risks and complications will be discussed prior to the procedure.

What do I have to do in the days before my Hysterectomy?

You can continue to take most regular medications unless we advise you otherwise. If you take blood thinners or certain diabetic medications you will be asked to cease these prior to surgery.
We will ask you to have a blood test one or two days before your surgery.
You will be admitted to the hospital on the day of your operation. You will be contacted by your anaesthetist the day before your surgery to discuss the anaesthetic and any concerns you may have. You will meet your anaesthetic before surgery.

Vaginal Hysterectomy

With a Vaginal hysterectomy, the uterus is removed through the vagina so there are no incisions in the abdomen. With a vaginal hysterectomy, the cervix is always removed.

Recovery following vaginal hysterectomy is much faster than abdominal hysterectomy but not as fast as a laparoscopic hysterectomy. You will be discharged from the hospital after two or three days.

Laparoscopic Hysterectomy

In this technique, the uterus is separated from its attachments to the pelvis via laparoscopy and removed through the vagina.

The procedure is done under general anaesthesia in an operating theatre. A small incision is made inside the umbilicus. The abdomen is inflated with CO2 -gas and a fibre-optic instrument called a laparoscope, inserted to view the internal organs.

Further small incisions are made in your abdomen through which tiny surgical instruments are passed. Then, the uterus and cervix are removed (and the tubes and/or ovaries if needed).

Laparoscopic hysterectomy has benefits such as:

Shorter Recovery Time
Faster Return to Usual Activities
Reduced Post Surgical Pain
Minimal Scarring
Less Risk of Adhesions compared with abdominal hysterectomy

Women are usually discharged the next day.

Sometimes a laparoscopic hysterectomy is not the best procedure for instance for large fibroid uteruses or where there is uterine prolapse present.

Abdominal Hysterectomy

With an abdominal hysterectomy, the uterus is removed through an incision into the lower abdominal wall. It can be made horizontally (a Pfannenstiel or bikini-cut) or vertically (in the midline). The main advantage is to the surgeon who has greater access to the pelvis.

This is performed if the uterus is significantly enlarged or if there is gross pelvic pathology including adhesions.

The most common reasons for abdominal hysterectomy are:

Severe Endometriosis
Large Uterine Fibroids: They are the non-cancerous growths in the uterus. If the fibroids are large, an abdominal hysterectomy is required.
Severe adhesions due to previous abdominal surgery or infection
Malignancy
Where a laparoscopic hysterectomy cannot be completed.

You will be in hospital for three to four days. Most women will return to work after 6 weeks.

What can I Expect During The Recovery Period?

You will be in the recovery room when you wake up from anaesthesia. You may feel sleepy for the next few hours. You can eat and drink normally as soon as you feel hungry, usually within a short period of time.
You should have minimal pain immediately after surgery and your anaesthetist will prescribe regular pain medication as well as more doses if your pain is not under control. We will send you home with pain relief. The pain usually peaks a day or two after surgery and then improves progressively so that most women will only need Paracetamol if anything one week after surgery. An abdominal hysterectomy is an exception as the incision into the abdomen (laparotomy) usually causes more pain and thus a slower recovery. You may feel tired for a few days after the procedure.
Constipation is very common. You will be in the hospital overnight following the procedure and may have to stay another day.
Light vaginal bleeding/spotting from the vagina is normal and will last for a few days to weeks after the surgery. The use of sanitary pads should be preferred as tampons increase the risk of infection. You will not have periods and cannot conceive after the vaginal hysterectomy.
After a laparoscopic hysterectomy, you may have pain in your right shoulder or back which is caused by trapped gas that is irritating the liver. It resolves within a day or two.
You should avoid strenuous activities or exercise for 4- 6 weeks. We recommend that you take 6 weeks off work because we cut and reattach important ligaments during the surgery and it needs time to heal. Prolonged sitting or standing can interfere with the healing process.
You may have some vaginal discharge (old blood) for several days after the procedure. After the procedure, you will no longer be menstruating and be unable to conceive. Avoid intercourse for 6 weeks - to allow the top of the vagina adequate time to heal.
Women have no change in sensation after a hysterectomy. Libido is not affected and may be improved with an improvement in wellbeing.