Hysterectomy is a procedure in which the Uterus of a woman is removed. The reason can be various. Hysterectomy can be performed either through the vagina or by making an incision in the abdomen/belly or through laparoscopy. Laparoscopy is an advanced procedure in which a few holes are made in the abdomen region to operate and remove the uterus.  Let us explore more on how hysterectomy is done using a laparoscope at our Urogynecology Clinic Chennai and under what circumstances does a gynecologist will recommend a person to go for a hysterectomy.

When does your gynecologist or urogynecologist suggest hysterectomy?

Medical conditions that will make your gynecologist prefer hysterectomy are as follows:

• Fibroids – Fibroids are benign tumors that grow on the walls of the uterus. They may grow outside or on the inside of the uterus.  Usually myometcomy is performed to remove fibroids but when they are recurring and if you don’t intend to get pregnant in the future, removal of uterus may be an option.
• Heavy or irregular menstrual periods. In women who are suffering from irregular menstrual periods due to various reasons, endometrial ablation procedure may be an option. If your gynecologist prefers hysterectomy instead, he/she may suggest you go for it.
• Recurring endometriosis and severe period pain.
• Risk of cancer to the cervix, uterus, ovaries or fallopian tubes
• Adenomyosis
• Prolapse of the uterus – when uterus falls off from its actual place into the vagina due to weakening of pelvic muscles that hold it in its place.
• Pelvic Inflammatory Disease.

What are the different types of hysterectomy?

Before getting into the different types of hysterectomy, you need to know the different parts of the female reproductive system.  Starting from the external vagina, as we move into the system, there exists the upper part of the vagina, then the cervix followed by the uterus. Connected to the uterus are the fallopian tubes which hold the ovaries at the other ends.  Every woman usually has two fallopian tubes with one ovary each.

There are five different types of hysterectomy depending on what organs are removed.

• Total Hysterectomy – Uterus and the cervix are removed.
• Sub Total (Partial) Hysterectomy – Only the uterus us removed by keeping the cervix in place. Usually cervix removal is suggested as it is a potential place for cancer to originate.
• Bilateral Salpinio-Oophorectomy – Uterus, fallopian tubes and ovaries are removed. Cervix is left in its place.  This is performed in women who have cancer of the uterus or ovaries and/or long term pelvic inflammation problem due to recurring infections.
• Radical Hysterectomy – Most extensive removal in which the uterus, fallopian tubes, ovaries, cervix, upper part of the vagina and associated pelvic ligaments and lymph nodes are removed. This is performed in cases when cancer is likely to spread to other nearby organs in the near term and to different parts of the body (metastasize) in long term.
• Prophylactic bilateral salpingectomy – removal of fallopian tubes along with uterus.

Advantages of laparoscopic hysterectomy vs conventional abdominal hysterectomy

In conventional hysterectomy, an incision is made in the lower abdomen and the uterus and other organs (as decided) are taken out.  The area that is cut open is sutured and left to heal with bandages and antibiotics.

In Laparoscopic Hysterectomy, few small incisions are made in the abdomen area through which few tubes are inserted. They serve as tools to operate and also have a camera to show the doctor, the inside picture of the body.  Once the removal of the uterus is done, the small incisions are sutured and bandaged, and treated with antibiotics.

• The time taken for laparoscopic hysterectomy is shorter than conventional hysterectomy.
• The amount of blood loss during laparoscopic hysterectomy is very less comparatively.
• Pain felt post hysterectomy operation is relatively much less in laparoscopic procedure.
• Since the incisions that are made are small, healing time significantly improves and the person can get back to normal life very quickly.
• Laparoscopic hysterectomy also leaves an option for patients to undergo scarless or keyhole surgery in which only one incision is made in the belly button.  This doesn’t leave any surgical scar that might look ugly after healing.
• With the advent of robotic technology, doctors are able to perform laparoscopic hysterectomy using robots.
• Laparoscopic and robotic hysterectomy gives the doctor better visibility of the internal organs leaving very minimal chance of errors or scarring/damage to other organs during the surgery.

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