All our Practitioners have skills in Laparoscopic (key hole) hysterectomy. You will be assessed if this method is suitable for you.
What is a Hysterectomy?
A hysterectomy is an operation to remove the uterus (the womb) and the cervix, or the neck of the womb. A total hysterectomy involves removing the uterus, cervix and fallopian tubes. Sometimes, it may be necessary to remove one or both ovaries.
After a hysterectomy, you will cease to have your periods. As the cervix is removed, there is no need for cervical smear tests.
Types of Hysterectomies
There are 4 types of hysterectomies:
- Abdominal hysterectomy – this is done by an incision on the abdomen which can either be horizontal or vertical midline incision. It is usually done for very large uteri or fibroids, multiple prior abdominal surgeries or if a concurrent abdominal procedure is needed.
- Vaginal hysterectomy – the operation is done via the vagina. This is usually the approach of choice if the uterus is descending or if you need a concurrent vaginal prolapse repair.
- Laparoscopic hysterectomy – the entire procedure is done via 3-4 small keyhole incisions over the abdominal wall. The uterus is delivered vaginally. The advantages of this is a quicker post op recovery as there are no abdominal incisions.
- Laparoscopic assisted vaginal hysterectomy – This is a combination of the keyhole and vaginal approach.
Why do I need a hysterectomy?
The commonest reasons are heavy bleeding, fibroids, menstrual pain and prolapse. Sometimes, a hysterectomy is offered if there is an abnormal cervix as detected on a cervical smear test and there is no desire for future fertility. This is usually the case after a detailed discussion with the patient as there are other simpler operative procedures to treat an abnormal cervix.
What will happen at my surgery?
On the day of your surgery, you will be admitted in the ward. In the operating suite, your anaesthetist will give you a general anaesthetic for the procedure. After positioning and appropriate precautions have been taken to protect your skin and joints, antiseptic wash is applied to the abdomen, upper thighs and vagina.
An indwelling catheter is inserted to keep the bladder empty continuously. An instrument is placed in the uterus to help with manipulating the uterus at the time of the hysterectomy. Four small incisions are made – one at the belly button, one just above the bladder area and two on either side of the abdomen. A camera is inserted and the internal organs viewed on a monitor/television screen.
Learn about Hysterectomy by watching this video.
The abdomen is inflated with carbon dioxide gas and slender instruments are inserted into the ports which may include tissue-grasping forceps, scissors, vessel sealing and tissue sealing devices. These instruments are used to perform the hysterectomy.
The uterus, tubes and sometimes, the ovaries are separated from its attachments and blood vessels. The bladder is moved aside to allow the cervix to be separated from the vagina and the uterus is then delivered into the vagina and out of the body. The vault, or the opening of the vagina that leads into the abdominal cavity is then closed with suture material that is absorbed over time.
At the end of the operation, meticulous care is taken to ensure there is no bleeding and photographs are taken with the laparoscopic camera. Local anaesthetic is usually instilled into the abdomen and the small wounds are closed with absorbable stitches.
Risks involved
All surgical procedures carry a degree of risks. Laparoscopic hysterectomy carries similar risks to a vaginal hysterectomy. There is a 0.5-1% risks of vessel, bowel, bladder and ureteric (tubes that carry urine from the kidney to the bladder) injury which are common risks to all hysterectomies.
Some risks are higher in specific cases (eg if you have had a previous abdominal procedure, a C Section scar, endometriosis etc). Please discuss these with your surgeon.
There is a small risk that you may need an abdominal incision if there are complications during the procedure.
Post op recovery
Once you are stable in the post op recovery suite immediately after the surgery, you will be transferred back to the ward for further recovery. A blood thinning agent called Clexane will be administered to prevent deep venous thrombosis.
You will be seen the next morning for a review and to discuss your operative findings. The catheter is usually removed in the morning and you are encouraged to start mobilising. You can usually have a normal diet. You should keep up with regular pain relief at least for the first 24 hours.
A physiotherapist will see you to talk about post op mobility and pelvic floor exercises. Most patients are ready to go home the second day after the surgery.
Post op visits
Our Practice nurse will usually see you 2 weeks after your operation to check your wounds or call you by telephone to check on your recovery at home. Please let our nurse know if you have any issues or if you are worried about any aspects of your recovery. Your gynaecologist will see you 6 weeks after the operation and perform an internal examination to ensure the vault is healing well.
If you have any post op concerns, or if you are unwell, please call our Rooms urgently or your General Practitioner. You may be instructed to come to the Launceston General Hospital for a review if needed.
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