Closed hysterectomy, in other words, laparoscopic hysterectomy is a surgical method that was first performed in 1989 and not considered as a very new method. Laparoscopy is referred to as ”closed surgery” in the community. Laparoscopic hysterectomy has become an inseparable part of modern medicine. Laparoscopy is the exploration of the internal organs by entering through the umbilicus using an optical instrument and performing surgical procedure with three instruments introduced through three 0.5 cm incision made in the lower abdomen. Ovary and uterus operations can be performed using the laparoscopic method. Especially in the surgery for ovarian cysts, it is used widely.
However, a special training and adequate experience are essential to be able to perform this procedure safely. Apart from that, laparoscopy has been started to be used more frequently in hysterectomy surgeries. The removal of the uterus and ovaries without making any incision on the patient’s abdomen can be obtained in this way. Operations carried out with laparoscopy do a very little damage to tissues and organs. So it is a conservative surgical method.
- Surgical control is better since the intraabdominal organs are observed by being magnified.
- The risk of inflammation and the chance of postoperative adhesion are lower since the abdomen is not opened.
- No scar is left and no abdominal hernia occurs since the abdominal wall is not incised.
- Postoperative pain is very little since the abdominal wall is not incised.
- The patient returns to daily life in a very short time. The average time to return to work varies from one week to fifteen days.
Hysterectomy, the ligaments that connect the uterus to the body are cut one by one by entering through the incisions made. The uterus is removed out of the body by vaginal route. Sutures are made using the laparoscopic methods. And if everything goes well, the patient is hospitalized for a day and discharged on the next day.
Hysterectomy, laparoscopy is a special specialty and should be carried out by doctors experienced in this field. If the doctor’s experience is not suitable for laparoscopy, then the operation should be performed as open surgery.
What is Hysterectomy?
Laparoscopy-assisted hysterectomy is a surgery performed under general anesthesia based on visualization of intraabdominal organs by introducing a fine telescope into the abdomen through the umbilicus. Abdominal approach is the most commonly preferred route in operations performed to remove the uterus. This procedure is very widely used by the department of obstetrics and gynecology. Hysterectomy, open surgery in which the abdomen is incised to remove the uterus and ovaries is rarely preferred instead of this method. In open surgery, more pain is felt as the abdomen is incised, the length of hospital stay is longer, and late complications for abdomen are more common.
Whereas, in laparoscopy, patients can be discharged the next day without any pain, and then they can return to daily life. The most important advantage is that the incisions made on the skin are very small.
The extent of the operation carried out inside is the same as the open surgery. The patient feels a slight pain, is hospitalized for a shorter period, and returns to work earlier. Recovery of the patient is faster and easier with vaginal hysterectomy. However, in the presence of abdominal pain, vaginal prolapse, urinary incontinence or adhesion suspicion in the patient, the laparoscopic approach would be more appropriate.
There are some limitations to understand whether patients are eligible for laparoscopy in hysterectomy. Laparoscopy is risky, especially for patients who previously underwent abdominal operations and accordingly have intraabdominal adhesions. Moreover, in the case of excessively large uterus, it may be difficult to remove the uterus laparoscopically. In addition, the use of laparoscopy is not recommended on patients at an advanced age, severe cardiac and pulmonary problems, overweight patients, called morbidly obese..
What are the Risks of Laparoscopic Hysterectomy?
No operation is risk-free. As with any surgery, laparoscopic surgery involves specific risks. However, severe complications are rare.
After the operation, urinary tract infection, surgical site infection, short-term urination difficulty, or venous obstruction may occur.
Organs such as bladder, urinary tract, intestines, vessels, and uterus may be injured during hysterectomy. It is possible to fix these injuries using the same method, i.e. laparoscopy.
Though rare, large-vessel injuries may occur. These wounds may be life-threatening. The risk of death during laparoscopy is one in a thousand.
Intraabdominal infection can be considered as other complications that may occur.
In the operations to be performed by experienced doctors, these risks will be minimized.