What is a Hysterectomy and What is Laparoscopic Hysterectomy?

Firstly, what is a hysterectomy? For many, it sounds scary but often without the understanding of what it actually is. A hysterectomy is the removal of a woman’s reproductive apparatus and is carried out for a number of reasons including dealing with heavy or irregular periods and suspected fibroids, and, in the case of a total hysterectomy, the procedure removes the possibility of you ever developing cancer of the womb or cervix.

Procedures of this kind are dominated by long, fancy words of Greek and Latin origin, which makes it a little confusing for women who don’t know the difference between oophorectomy and laparoscopy. In this blog, we’re going to look at one of these terms: laparoscopic hysterectomy (or ‘keyhole’ hysterectomy).

A laparoscope is a long tube with a high-intensity torch and a high-resolution camera fixed to the end. This allows us to see what’s going on internally without opening the patient up.

What’s the point of keyhole surgery?

Generally speaking, the less cutting we have to do when operating, the better. Several small cuts in your abdomen will heal more quickly and more completely than a single larger one. This means less bleeding, less time spent in hospital, and a decreased chance of complications developing.

What happens during keyhole surgery?

So how small are these ‘keyholes’, exactly? Well, they’re around the size of the keyhole on your front door (that’s the bigger mortice sort, not the smaller cylinder ones). There are usually three of them made during the surgery.

The first incision is the one that the camera will go through. It’ll be made just beneath the belly-button. The surgeon will also use this hole to fill the abdomen with CO2 – this allows the team to see what’s going on. Another two incisions will then typically be made to accommodate cutting and grasping devices, which will allow the team to move the other internal organs out of the way and remove the reproductive organs.

How do I know if laparoscopic surgery is right for me?

Your doctor will be able to advise you on whether laparoscopy suits your circumstances. But we’re still left with the general question: if laparoscopy is so fantastic, then why aren’t all hysterectomies carried out in this way?

Well, there are some factors which might make laparoscopy less convenient, particularly when the womb (uterus) is enlarged such as the case with fibroids. The main problem here is that the large womb may not be easily deliverable through the vagina after taking it out. In these cases, it would be necessary to use a device called a morcellator. It’s something I only tend to use in selected cases of laparoscopic myomectomy (removal of fibroids) while some other consultants use it if subtotal hysterectomy is required (which means the removal of the womb but leaving the neck of the womb (cervix). Your consultant will always talk to you more about this.

Mr Gelbaya is an experienced, senior consultant gynaecologist, being one of the surgeons that started offering laparoscopic surgery including laparoscopic hysterectomy in Leicestershire more than 10 years ago. Mr Gelbaya has also taught (trained) many other gynaecologists how to do it.