Cause / Condition
Hysterectomy is the removal of the uterus surgically. Subtotal hysterectomy is the removal of the uterus while leaving the cervix or the lower end of the uterus behind. Salpingo-oophorectomy refers to the removal of the fallopian tube and ovary, which may accompany the hysterectomy in appropriate situations. Hysterectomy alone does not precipitate the menopause. A surgical menopause occurs when both ovaries are removed.
The most common reasons for hysterectomy in the USA are excessive or irregular bleeding, uterine fibroids, endometriosis, prolapse, cancer, and others. Most cases of abnormal bleeding may be controlled by the use of hormone pills, progesterone containing IUD, resection of submucous fibroid, or endometrial ablation (see LINK). Because of these alternatives hysterectomy should rarely be needed for abnormal bleeding.
For endometriosis, hysterectomy is usually unnecessary and is largely performed because of ignorance of contemporary concepts of endometriosis treatment and surgery. Similarly, hysterectomy should never be performed for uterine fibroids when childbearing is desired. It is always possible to do a myomectomy.
About the Procedure
The technique for Total Laparoscopic Hysterectomy as performed at our institute was originated by Dr. Charles Koh, who also designed the equipment (KOH Colpotomizer) for achieving this operation laparoscopically.
A Total Laparoscopic Hysterectomy of a normal uterus takes less than sixty minutes, while difficult cases may take up to 2 ½ hours. A ½-inch belly button incision together with three other ¼-inch incisions are used.
A very important feature of the KOH technique is the preservation of the length of the vagina at Total Laparoscopic Hysterectomy. The uterosacral ligaments (which provide the support for the vagina) are not cut unlike other methods of hysterectomy including vaginal hysterectomy as well as hysterectomy by laparotomy (open abdominal incision). Occasionally a subtotal hysterectomy is performed at a patient’s request.
Recent data from good studies have shown that the belief that retaining the cervix is necessary to maintain a woman’s sexual response is erroneous. Neither does it prevent prolapse after hysterectomy.
Another important aspect of the laparoscopic hysterectomy technique is the suturing of the vaginal vault and the uterosacral ligaments to prevent future prolapse.
A few patients have gone home the same day after a hysterectomy, while the majority stay overnight and are discharged within twenty-three hours. Less than 10% of women stay for two nights and this is usually because the operation is more extensive with treatment of endometriosis or prolapse occurring together with the hysterectomy.
Some patients have returned to work within three days even driving themselves, while a more usual recovery time is around two weeks.
Expectations / Experience
With the laparoscopic approach to hysterectomy by the technique practiced at our institute, operative times are short and pain is minimized during recovery. We feel that this technique is a gentler form of hysterectomy which benefits every woman who will require a hysterectomy.
On the other hand, because of our institute’s commitment to appropriate treatment based on the condition, most patients with fibroids, endometriosis and adhesions have their primary condition treated rather than undergo a hysterectomy.
Injuries to the bladder or ureter may occur during hysterectomy whether it is performed vaginally, by the open laparotomy or by laparoscopy. Bowel injury may occur when there is extreme adherence of the bowel. Most injuries that are detected during laparoscopy are treated at laparoscopy without resorting to a laparotomy. Other complications are more generic related to surgery in general or laparoscopy.
For more information contact:
The Milwaukee Institute of Minimally Invasive Surgery
Columbia St. Mary's Hospital Milwaukee
2301 N. Lake Dr.
Milwaukee, WI 53211