Our Summary

This research paper is about a study that was done to assess if a total laparoscopic hysterectomy (TLH), a kind of surgery where the uterus is removed through small incisions in the abdomen, can be done safely and effectively without using a uterine manipulator (a device typically used to position the uterus during the procedure). The study looked at 1023 patients who had this surgery for non-cancerous reasons between January 2011 and January 2020.

The study found that the surgery was relatively quick, with an average time of 78 minutes, and there wasn’t a lot of blood loss. There were a few complications, like injury to the ureter (the tube that carries urine from the kidneys to the bladder) and the bladder, but these were rare. Most patients were able to leave the hospital after just over a day.

The researchers concluded that this type of surgery could be done without a uterine manipulator and that it was a safe and effective procedure. It was suggested that this technique might be a good starting point for doctors learning to do this type of surgery.

FAQs

  1. What is a total laparoscopic hysterectomy and how is it typically performed?
  2. What were the findings of the study on total laparoscopic hysterectomy without using a uterine manipulator?
  3. How safe and effective is a total laparoscopic hysterectomy without using a uterine manipulator according to this study?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about hysterectomy is to be prepared for a recovery period and to follow post-operative instructions carefully. This may include taking pain medication as prescribed, avoiding heavy lifting and strenuous activities, and attending follow-up appointments to ensure proper healing. Additionally, it is important to communicate any concerns or changes in symptoms to your healthcare provider.

Suitable For

Patients who are typically recommended hysterectomy include those with:

  1. Uterine fibroids: These are noncancerous growths in the uterus that can cause symptoms such as heavy menstrual bleeding, pelvic pain, and pressure on the bladder or bowel.

  2. Endometriosis: This is a condition where tissue similar to the lining of the uterus grows outside of the uterus, causing pain and sometimes infertility.

  3. Uterine prolapse: This is when the uterus slips down into the vaginal canal due to weakened pelvic floor muscles.

  4. Abnormal uterine bleeding: This can be due to various causes such as hormonal imbalances, polyps, or adenomyosis (when the lining of the uterus grows into the muscle wall).

  5. Chronic pelvic pain: This can be due to various conditions such as adenomyosis, endometriosis, or fibroids.

  6. Gynecologic cancers: In cases of uterine, cervical, or ovarian cancer, a hysterectomy may be recommended as part of the treatment plan.

It is important for patients to discuss their specific condition with their healthcare provider to determine if a hysterectomy is the best treatment option for them.

Timeline

Before the hysterectomy:

  • Patient consults with their gynecologist to discuss the reasons for the surgery and alternative treatment options.
  • Patient undergoes preoperative testing, such as blood work and imaging studies, to assess their overall health and determine if they are a candidate for surgery.
  • Patient may need to make lifestyle changes, such as quitting smoking or losing weight, to improve their surgical outcome.
  • Patient meets with the surgeon to discuss the procedure, potential risks and benefits, and what to expect during recovery.

After the hysterectomy:

  • Patient is taken to the recovery room immediately after surgery to be monitored for any complications.
  • Patient may experience pain and discomfort in the days following the surgery, which can be managed with pain medication.
  • Patient will need to rest and avoid strenuous activities for several weeks to allow the body to heal.
  • Patient will have follow-up appointments with their surgeon to monitor their recovery and address any concerns or complications.
  • Patient may experience changes in their menstrual cycle, menopausal symptoms, and emotional adjustments following the surgery.

What to Ask Your Doctor

  1. What are the different types of hysterectomy procedures available and why is a total laparoscopic hysterectomy (TLH) being recommended in my case?

  2. What are the potential risks and complications associated with a TLH procedure without a uterine manipulator?

  3. How experienced is the surgeon in performing TLH procedures without a uterine manipulator?

  4. What is the expected recovery time and post-operative care after a TLH procedure without a uterine manipulator?

  5. Will there be any long-term effects or changes in my body after undergoing a TLH procedure without a uterine manipulator?

  6. Are there any alternative treatment options to consider before deciding on a hysterectomy?

  7. How will a hysterectomy affect my hormone levels and menopausal symptoms?

  8. Will I still be able to have children or experience sexual pleasure after a hysterectomy?

  9. How often will I need to follow-up with my doctor after the procedure?

  10. Are there any lifestyle changes or precautions I should take before and after the surgery?

Reference

Authors: Zygouris D, Chalvatzas N, Gkoutzioulis A, Anastasiou G, Kavallaris A. Journal: Eur J Obstet Gynecol Reprod Biol. 2020 Oct;253:254-258. doi: 10.1016/j.ejogrb.2020.08.035. Epub 2020 Aug 26. PMID: 32898770