Our Summary

The research aimed to find the best surgical method for removing large uteruses. The team looked at previous studies and databases, focusing on surgeries that solely removed the uterus and/or the fallopian tubes and ovaries, and excluded operations related to other gynecological or obstetric issues.

The review included 25 studies, and found that total vaginal hysterectomy (removal of the uterus through the vagina) took less time compared to laparoscopically assisted vaginal hysterectomy (removal of the uterus through small incisions in the abdomen assisted by a camera) and total laparoscopic hysterectomy (removal of the uterus entirely through small incisions in the abdomen).

The study also found that the risk of damaging the ureters (tubes that carry urine from the kidneys to the bladder) was much higher in total laparoscopic hysterectomy compared to total vaginal hysterectomy. However, the risk of bowel injury was the same for all methods.

When comparing the amount of blood loss during surgery, abdominal hysterectomy (removal of the uterus through a large incision in the abdomen) had a much higher risk compared to robotic-assisted total hysterectomy (removal of the uterus using a robot-assisted surgical system).

In conclusion, minimally invasive methods (vaginal, laparoscopic, or robotic) are safe and effective, with fewer complications. These methods result in less blood loss and a shorter hospital stay, while the traditional abdominal method has a shorter surgery time.

FAQs

  1. Which surgical method was found to be the best for removing large uteruses?
  2. What are the risks associated with total laparoscopic hysterectomy compared to total vaginal hysterectomy?
  3. How does the amount of blood loss during an abdominal hysterectomy compare to a robotic-assisted total hysterectomy?

Doctor’s Tip

One helpful tip a doctor might give to a patient considering a laparoscopic hysterectomy is to discuss the potential risks and benefits of the procedure compared to other surgical methods. It’s important to weigh factors such as surgery time, risk of complications like ureter or bowel injury, blood loss, and recovery time. Having an open and honest conversation with your doctor can help you make an informed decision that is best for your individual circumstances. Additionally, following your doctor’s pre and post-operative instructions can help ensure a successful recovery.

Suitable For

Patients who are typically recommended for laparoscopic hysterectomy are those with:

  • Large uteruses
  • Need for removal of the uterus only
  • Need for removal of the fallopian tubes and ovaries
  • Desire for a minimally invasive surgical approach
  • Lower risk of ureter damage
  • Lower risk of blood loss
  • Desire for a shorter hospital stay

Timeline

Before laparoscopic hysterectomy:

  1. Patient consults with gynecologist about symptoms and treatment options for conditions such as fibroids, endometriosis, or abnormal bleeding.
  2. Patient undergoes pre-operative tests and evaluations to ensure they are a suitable candidate for surgery.
  3. Patient discusses surgical options with their healthcare provider and decides on laparoscopic hysterectomy.
  4. Patient prepares for surgery by fasting and following instructions provided by the healthcare team.

During laparoscopic hysterectomy:

  1. Patient is given anesthesia to induce unconsciousness and prevent pain during the procedure.
  2. Surgeon makes small incisions in the abdomen to insert a laparoscope and surgical instruments.
  3. Surgeon removes the uterus and any other affected organs, such as the fallopian tubes or ovaries, using the laparoscopic technique.
  4. Surgery typically lasts 1-2 hours, depending on the complexity of the case.

After laparoscopic hysterectomy:

  1. Patient wakes up in the recovery room and is monitored for any complications.
  2. Patient may experience pain, bloating, and discomfort in the abdomen, which can be managed with pain medication.
  3. Patient is advised to rest and avoid heavy lifting or strenuous activities for several weeks following surgery.
  4. Follow-up appointments with the healthcare provider are scheduled to monitor healing and address any concerns or complications.
  5. Patient may experience improvements in symptoms such as pelvic pain, heavy bleeding, or other issues that led to the decision for surgery.

What to Ask Your Doctor

Possible questions a patient may want to ask their doctor about laparoscopic hysterectomy include:

  1. What are the potential benefits of a laparoscopic hysterectomy compared to other surgical methods?
  2. What are the risks and potential complications associated with a laparoscopic hysterectomy?
  3. How long is the recovery time after a laparoscopic hysterectomy?
  4. Will I need to stay in the hospital after the surgery, and if so, for how long?
  5. How experienced are you in performing laparoscopic hysterectomies?
  6. Will I be a good candidate for a laparoscopic hysterectomy based on my medical history and current condition?
  7. Will I need any additional tests or evaluations before the surgery?
  8. What type of anesthesia will be used during the laparoscopic hysterectomy?
  9. How will my pain be managed after the surgery?
  10. What should I expect in terms of scarring and post-operative care following a laparoscopic hysterectomy?

Reference

Authors: Mamik MM, Kim-Fine S, Yang L, Sharma V, Gala R, Aschkenazi S, Sheyn D, Howard D, Walter AJ, Kudish B, Balk EM, Antosh DD. Journal: Obstet Gynecol. 2024 Jul 1;144(1):40-52. doi: 10.1097/AOG.0000000000005607. Epub 2024 May 15. PMID: 38743951