Laparoscopic Hysterectomy for benign gynaecological conditions

Many women are understandably ambivalent and anxious when told that they may need to undergo abdominal hysterectomy (a major procedure for removal of the uterus).   This is because abdominal hysterectomy often conjures up image of a large cut, prolonged recovery, anecdotal stories of emotional, psychological, sexual and hormonal disturbance.

When carefully considered and performed for the right indication, hysterectomy can significantly improve the quality of life for many women, particularly if done through the vaginal or laparoscopic approaches. 

What are the reasons and common benign indications for hysterectomy?

  • to relieve pain and excessive menstrual bleeding  caused by conditions such as endometriosis, adenomyosis or pelvic infection 
  • to relieve pelvic pressure caused by fibroids
  • to treat certain types of prolapse of the uterus 

What are the methods of hysterectomy?

There are 3 approaches to hysterectomy – abdominal, vaginal and laparoscopic.

The abdominal approach means a long abdominal incision from which women often require 5 to 7 days of hospital stay.

The vaginal hysterectomy approach allows removal of the uterus via an incision through the top of the vagina.The vaginal route is suitable where the uterus is prolapsed and not too large in size.

The laparoscopic route involves 3-4 small skin incisions, through which long, thin instruments are used while the image is projected onto a television screen.   

What are the benefits of laparoscopic hysterectomy?

In 2011, the AAGL, the premier association representing the largest number of laparoscopic surgeons globally, published the AAGL Position Statement: Route of Hysterectomy to Treat Benign
Uterine Disease available at  https://www.ncbi.nlm.nih.gov/pubmed/?term=AAGL+2011+statement+on+hysterectomy with the aim to inform the public of the existence of robust evidence showing that vaginal and laparoscopic approaches are less invasive, associated with less pain, reduced morbidity and faster recovery than abdominal hysterectomy .  

CARE database supports the AAGL Statemen in that laparoscopic hysterectomy, in experienced hands results in significantly better and safer outcomes when compared with abdominal hysterectomy.  

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