Total Laparoscopic Hysterectomy in Delhi, India

A woman may opt for a hysterectomy when experiencing the following symptoms/conditions:

• Painful or heavy periods (AUB)
• Fibroids
• Prolapse of uterus
• Endometriosis
• Ovarian cysts or tumours
• Cancer of the reproductive system - uterus, cervix or ovaries cancer
• Pelvic inflammatory disease
• Post-menopausal bleeding

Various imaging techniques can be used for diagnosing conditions that require a laparoscopic hysterectomy. Some include CT scans, MRIs, and ultrasounds (sonography). These scans help the doctor get clear pictures of the condition of the organ to be treated and the surgical site. Cervical cytology (pap test) may be carried out to detect the presence of cancer cells. An endometrial biopsy may be advised to detect abnormal cells along the uterine lining.

A total laparoscopic hysterectomy is performed under general anaesthesia. The following steps are involved in the procedure:

• A narrow cannula is inserted into a vein of the arm using a needle to inject fluids and medications.
• After the general anaesthetic is administered and the patient is asleep, a catheter is inserted into the bladder to drain urine.
• A small incision of about 2 cm is made near the navel to create an entry point for the laparoscope.
• The abdomen is filled with gas. After which, the laparoscope is inserted to view the internal organs clearly through the optical device on an attached TV screen. After this, two or more incisions are made on the abdomen to insert more instruments.
• The surgeon now performs the surgery and closes the incision with stitches once the procedure is completed.
• The procedure can take about two and a half hours, with 3 to 4 hours of recovery.

Patients who have been diagnosed with the following may be advised a total laparoscopic hysterectomy:

• Gynecologic cancer: A hysterectomy may be the best treatment option for patients with gynecologic cancer, such as cancer of the uterus or cervix.
• Fibroids
• Endometriosis
• Adenomyosis
• TLH may be indicated for the resection and debulking of both cancerous and precancerous diseases, especially endometrial and cervical cancer, as noted by extensive case series in the gynecologic oncologic literature
• Uterine prolapse
• Abnormal uterine bleeding
• Chronic pelvic pain

Patients who can bear the stress of the surgery and are otherwise healthy can opt for this treatment.

Patients who are experiencing the following are not ideal candidates for a total laparoscopic hysterectomy:

• The presence of severe adhesive diseases (endometriosis) requires major surgical procedures (severe endometriosis).
• Major contraindications for TL are a large uterus, leiomyoma, or any other anatomic limitation that prevents a safe entry or adequate access for surgery.
• TLH is also not advised to diagnose and treat a suspicious pelvic mass that cannot be removed in toto.
• If the uterus is bigger than a 4-month pregnancy, TLH might not be the treatment choice.
• If the patient has had multiple previous operations in the lower abdomen, TLH might not be helpful.

• Before the surgery, a pre-screening appointment is scheduled. This may be on the same day as the outpatient clinic appointment or another day. This appointment is expected to ensure the patient is fit for the surgery.
• A few tests, such as blood tests, chest x-rays, and ECG (heart recording), may be carried out. Any concerns pertaining to the surgery can be discussed at this appointment.
• Smoking can complicate postoperative recovery. It is thus advisable to avoid smoking at least a month before the planned date of surgery.
• Since the surgery is carried out under general anaesthesia, one must fast for at least 8 hours before surgery.
• Discussing with the doctor about taking regular medicines with a sip of water in the morning before the procedure shall be helpful.

After the procedure, some of the common side effects that are imminent are:

• Pain, swelling and bruising on the abdomen or in the vaginal area.
• Vaginal discharge
• Bloated stomach
• Urinary tract infection (UTI)
• Adhesions (tissue sticking together)
• Injury to the bladder, ureters, bowel or blood vessels may indicate further surgery.
• Blood loss that may require in a blood transfusion
• Anaesthetics carry minor risks as some medical problems might increase those risks or unexpected reactions to the anaesthetic agent administered.
• Thromboses (DVT or PE) blood clots in the leg or chest
• Infection of the urine/chest/wound/intra-abdominal

These risks are uncommon and shall be discussed with the patient before the surgery.

Minor abdominal discomfort after surgery is common. These are termed “wind pains”. This occurs due to medical air inside the abdomen and should stop within a few days.

• Drinking peppermint cordial in warm water, staying active and passing gas can help recover faster.
• Minor vaginal bleeding for up to three weeks or intermittent spotting may occur for several weeks.
• One must avoid using tampons, and it is advised to use a sanitary pad.
• In case of any fresh bleeding or offensive, smelly discharge after leaving the hospital, immediately inform the doctor.
• The sutures placed near the vagina will not need removal since they are dissolvable sutures.
• It is crucial to maintain excellent hygiene since it reduces the risk of infection.
• Regular showers and maintaining personal hygiene are recommended.
• Weakness is a critical postoperative issue. To prevent this, one must eat a well-balanced and healthy diet.
• A hysterectomy can also be emotionally stressful, altering moods frequently.
• The body may take up to six weeks to recover, but recovery varies from person to person.
• After four to eight weeks of surgery, one may return to work to allow adequate rest and recovery time.
• The area near the vagina where the cervix was will have stitches which will require about 12 weeks to heal before intercourse can be resumed, or as advised by the consultant.
• Driving can be resumed after four weeks of surgery.

Reviewed by Dr. Seema Jain, Director, Obstetrics And Gynaecology, Robotic Surgery on 13-Apr-2023.

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