- Hysterectomy is one of the most common gynecological surgical procedures.
- It is estimated that 25% of women in the USA will have a hysterectomy.
- Reich and his group performed the first laparoscopic hysterectomy; and they highlighted advantages over the conventional one.
- LH was introduced with the purpose of replacing the abdominal one, mainly in women in whom it could not be performed vaginally.
- The advantages of laparoscopic hysterectomy are well established:
- Less post-operative pain,
- Short hospital stay and
- Rapid patient recovery
Malignant Pathology
- Early stage cervical cancer.
- Early Stage Endometrial Cancer.
- Early Stage Ovarian Cancer.
Benign Pathology
- Myomatosis.
- Adenomyosis.
- Endometrial hyperplasia.
- Endometriosis.
- Abnormal uterine bleeding.
- Chronic pelvic pain related to adhesions, secondary to pelvic inflammatory disease.
Contraindications for laparoscopic Access
- Inexperienced surgeon.
- Bowel obstruction.
- Paralytic ileus.
- Peritonitis, unless it is to evaluate a pelvic inflammatory disease or ovarian tube abscess.
- Bleeding in an unstable patient.
- Diaphragmatic hernia.
- Severe cardiorespiratory disease.
Laparoscopic Operability
- Mobility of annexes.
- Size of the uterus.
- Presence of adhesions.
- Presence of endometriosis.
- Access to the Douglas Sack.
Types of Laparoscopic Hysterectomy
- Diagnostic Laparoscopy with Vaginal Hysterectomy.
- Laparoscopic Assisted Vaginal Hysterectomy (LAVH).
- Laparoscopic Hysterectomy.
- Total Laparoscopic Hysterectomy (TLH).
- Supracervical Laparoscopic Hysterectomy (SLH).
- Vaginal Hysterectomy with Laparoscopic Dome Suspension.
- Laparoscopic Hysterectomy with Lymphadenectomy.
- Laparoscopic Hysterectomy with Lymphadenectomy and Omentectomy.
- Laparoscopic Radical Hysterectomy with Lymphadenectomy.
Disadvantages and limitations
- Coordination of the surgical team.
- Limitation of some maneuvers.
- Lack of tactile sensitivity.
- Surgical Training.
- More expensive equipment, low availability in all hospitals.
- Blind organ injury.
Advantages
- Less pain.
- Less trauma and adhesions.
- Shorter recovery time.
- Reduces hospitalization time.
- Early post-operative ambulation: Reduces pneumonia, thrombophlebitis, paralytic ileus, neo-adhesion formation, etc.
- Smaller, more aesthetic, less painful incisions, with lower rate of infection and keloid scarring.
- Better visualization.
- Excellent vision of the pelvis.
- Magnification 6-8 times.
- It establishes the diagnosis of endometriosis, bladder, ureter, vessels.
- Minor trauma.
- Peritoneal cavity doesn’t open.
- No drying out of tissues.
- The fabric is not exposed to continuous traction, pinching, foreign bodies, manipulation.
