The Procedure Called Total laparoscopic Hysterectomy


Hysterectomy refers to the removal of the uterus for pain, bleeding, uterine fibroids or endometriosis. When to perform a hysterectomy, who to have your surgery with, and what type of surgery to have is of ongoing discussion. Whether the hysterectomy is done through an abdominal incision (abdominal hysterectomy), through the vagina (vaginal hysterectomy), the terms that determine the extent of the hysterectomy are the same. If the cervix is retained it is referred to as a supracervical hysterectomy. If the ovaries are removed it is referred to as an oophorectomy, and if the fallopian tubes are removed it is called a salpingectomy. So a removal of all the pelvic structures is called a complete hysterectomy would be a hysterectomy plus a bilateral (both sides) total hysterectomy with bilateral salpinoophorectomy. The type that is best for you will vary by surgeon selection. Using a laparoscope or a procedure called laparoscopy, the hysterectomy itself is the Laparoscopic Assisted Vaginal Hysterectomy or a Total Laparoscopic Hysterectomy. Laparoscopy essentially a camera directed set of very small diameter instruments; the procedure is the least invasive. The procedure usually requires a patient to be asleep under general anesthesia. The tubes are placed in the locations needed, they may then be manipulated by the surgeon at your bedside or by the surgeon at a remote station known as robotic surgery. and once the uterus is completely free in the abdomen it is removed through the vaginal opening. The procedure is able to be performed because the bowel is held away through gravity and instrumentation, and the abdominal wall is pouched out by the infusion of gas into the abdomen. The blood vessels, supporting structures and the overlapping tissues are first sealed and then cut with heat. After the procedure is done a woman has a few ¼ inch incisions, rarely these extend to about ½ or ¾ of an inch. The advances in safe bipolar cutting energy, and tools to help a surgeon operate and push the areas cut away from other vital organs, as well as techniques to prevent the loss of gas, have made the total laparoscopic hysterectomy the best type of hysterectomy for many women. It also has the advantage of other low invasive procedures as being very cost effective. I suggest my patients come in to discuss whether a hysterectomy is indicate in your case and if it is, what is the best way to accomplish this so that you get back to full activities as quickly as is possible. Watch for other posts on the procedure of Total Laparoscopic Hysterectomy. For most women the procedure that is the least invasive is going to have the fewest complications, the shortest hospital stays, and faster recoveries. In a review published in the Cochrane Database it was still showing that vaginal hysterectomies are still the least invasive for most women. At Women's Health Practice that is what we endorse. The next least invasive procedure is going to be one of the laparoscopic surgeries, with robotic surgeries lasting a bit longer, and being a bit more expensive than the other alternatives. Call Womens' Health Practice for information and to see if you have first exhausted your alternatives to hysterectomy.

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