Hysterectomy (laparoscopic and abdominal approach)

Specialist:
Peng-Hui Wang
Yi-Jen Chen
Chi-Mu Chuang
Hua-Hsi Wu
Huann-Cheng Horng
Yen-Hou Chang
Ling-Yu Jiang
Hei-Yu Lau

Overview

A hysterectomy is a surgical procedure that involves removing a woman's uterus. There are several types of hysterectomies, including supracervical or subtotal hysterectomy, total hysterectomy, and radical hysterectomy. The type of hysterectomy performed depends on the reason for the surgery and can include treating uterine fibroids, uterine prolapse, cancer, endometriosis, abnormal vaginal bleeding, chronic pelvic pain, or adenomyosis.

Procedure

Abdominal Hysterectomy:

An abdominal hysterectomy is an open surgery that involves making a 5-7 inch incision across the belly to remove the uterus. This is the most common type of hysterectomy and usually requires a 2-3 day hospital stay. The recovery time can be long, and there will be a visible scar at the incision site.

Laparoscopic-Assisted Vaginal Hysterectomy:

This type of hysterectomy is performed by gynecologists with advanced skills in laparoscopic surgery. The advantages of this type of surgery include small incisions, quicker recovery, less bleeding, and fewer complications. During the procedure, the patient is placed in the Trendelenburg position and undergoes general anesthesia. The uterus is removed either through the vagina or the abdomen, and the incisions are closed with absorbable suture.

Notifications

Risks and Complications of Abdominal Hysterectomy:

There are several risks associated with abdominal hysterectomy, including wound infections, blood clots, hemorrhage, and injury to surrounding organs. There is also the potential for fistula formation and intra-abdominal adhesions that can cause chronic pain.

Risks and Complications of Laparoscopic-Assisted Vaginal Hysterectomy:

There are some risks associated with this type of surgery, including conversion to laparotomy (2.7-3.9%), infection (5%), venous thromboembolism (1-3%), nerve injury (0.2-2%), and genitourinary or gastrointestinal tract injury (0.1-2%).

Figure 1 (A) Laparoscopic-Cart (B) Laparoscopic-Digital camera (C) Laparoscopic energy devices

Figure 2 (A) Trendelenburg position (B) Laparoscopic operative room setup

Reference of Figure

1. (A)(B) Atlas of Operative Laparoscopy and Hysteroscopy - 3rd Edition (B) Atlas of Pelvic Anatomy and Gynecologic Surgery 4th Edición
2. (A) From the NursesPost.com (B) King CR, Giles D. Total Laparoscopic Hysterectomy and Laparoscopic-Assisted Vaginal Hysterectomy. Obstet Gynecol Clin North Am. 2016 Sep;43(3):463-78