Total laparoscopic hysterectomy is a procedure that was developed in the late 90’s, superseding the older Laparoscopically assisted Vaginal Hysterectomy.
Dr Gordon helped pioneer development in some of the earlier instrumentation used for total laparoscopic hysterectomy in conjunction with several other Australian gynaecologists.
It was quickly proven that blood loss was reduced, operating times were similar, and complications from surgery were reduced in the superior total laparoscopic hysterectomy procedure. The learning curve for total laparoscopic hysterectomy is predictable, with most surgeons learning this technique proven to be safe and proficient with 100 total laparoscopic hysterectomies completed.
As of early 2020, Dr Gordon has completed in excess of 2400 total laparoscopic hysterectomy procedures over the last 22 years, with a zero complication rate!
How do I prepare for a laparoscopic hysterectomy?
The preparation for hysterectomy involves a pre-operative meeting with the gynaecologist to discuss the merits of removing Fallopian tubes (which carry a small risk of promoting certain types of ovarian cancer), and the reasons to preserve or remove ovaries as well as all other surgery preparation steps. It is Dr Gordon’s opinion that at least one normal ovary should be preserved until post-menopause, thereby retaining normal oestrogen levels (for bone, heart, brain etc).
For women with a uterus larger than 700cc, total laparoscopic hysterectomy may not be the best choice; access around the uterus to identify vital structures (ureters, bowel) can be impaired with the very large uterus. In these situations, Open or robotic surgery may be more appropriate choices by the operating surgeon. The sole advantage of robotic surgery is that the instruments are articulated, allowing the surgeon to operate ‘around corners’ safely.
How long does a total laparoscopic hysterectomy take?
The procedure takes approximately 1.5-2 hours, sometimes twice that if there is extensive endometriosis present during surgery. In the woman with the average sized uterus, total laparoscopic hysterectomy allows perfect vision, safe access to all vital structures, minimal risk of bleeding, and the opportunity to carefully support the vaginal vault thereby minimising the risk of prolapse.
How long are you off work for a laparoscopic hysterectomy?
Whilst an abdominal hysterectomy may be quicker, the recovery from a total laparoscopic hysterectomy is measured in days, not weeks. The average in-hospital stay with a total laparoscopic hysterectomy is 2-3 nights, driving a car within a week, and as with any hysterectomy procedure, no intimacy or heavy lighting for ~8 weeks. Most patients are back to work within 2-3 weeks – around half the time of an open hysterectomy.
What to expect after a laparoscopic total hysterectomy?
Surprisingly, the recovery from a total laparoscopic hysterectomy procedure is very straightforward.
Almost all patients are mobile within 24 hours, all drains and tubes are removed within 24-48 hours of surgery, and sutures in the 4 port-holes are removed via the GP in a week from surgery; in many respects, the recovery is similar to most other laparoscopic (key-hole) procedures.
When ovaries are retained, there is almost never any observable menopausal change. When ovaries are removed electively, patients will require administration of transdermal oestrogen, at least in the short term. Bone density testing, and review by an endocrinologist may be necessary in patients with complicated medical histories.
For the patient with severe adenomyosis, endometriosis, and with an obliterated Pouch of Douglas, it would be usual to perform a hysterectomy and bowel reaction as a single procedure with an experienced gynaecologist and colorectal surgeon in attendance.
Such procedures are always best completed laparoscopically (even when bowel resection is undertaken as planned); there is no advantage in robotic surgery in this highly complex surgery. These combined procedures can take between 4-6 hours, depending on the extent of pathology. The average in hospital stay is 4-5 days (not 2-3 days as per simple total laparoscopic hysterectomy.
Total laparoscopic hysterectomy is a very advanced surgical technique, particularly when removing endometriosis or limited bowel resection is involved as part of a larger planned procedure.
With over 20 years of experience, Dr Gordon will plan and discuss the best treatment options with each patient individually.