Laparoscopic Hysterectomy: A Minimally Invasive Option for Faster Recovery
By Christina Litherland M.D.

Hysterectomy is the second most common surgery performed for women, second only to cesarean section. Approximately 600,000 women undergo hysterectomy every year. Like many other types of surgery, there are now newer, minimally invasive hysterectomy options to provide patients with faster recovery, less pain and fewer complications.

The typical indications for hysterectomy include menorrhagia, fibroids, pelvic organ prolapse, pelvic pain or endometriosis, and precancer or cancer. The different indications often dictate the approach or type of incision. For many of the indications, however, the approach is decided by the physician’s experience and comfort with the different surgical options.

There are now several different ways to access the pelvic organs. Hysterectomies can be performed abdominally, vaginally, or using a laparoscope. Total abdominal hysterectomy (TAH), the most common, typically has larger blood loss, longer hospital stay, slower recovery, and more major complications when compared to both vaginal hysterectomy and laparoscopic hysterectomy. A hysterectomy can either be total or partial, otherwise called supracervical. A supracervical hysterectomy removes the uterus while retaining the cervix. Both supracervical and total hysterectomies can be performed either abdominally or with a laparoscope.

A laparoscopic hysterectomy involves eliminating the blood supply to the uterus and either amputating the uterus from the cervix (LSH) or removing both the uterus and cervix (total laparoscopic hysterectomy or TLH).  The uterus is then morcellated into small pieces and removed through the laparoscopic ports.  Most patients have 3 to 4 incisions less than 1.5 cm in size.  

When a hysterectomy is performed with a laparoscope, studies have documented less blood loss, fewer major complications, and shorter hospitalization. Most patients only stay overnight, with some patients even leaving later on the same day of surgery. Typical recovery is about two weeks, with patients going back to work relatively quickly, compared to the six-week recovery of a TAH. Leaving the cervix in an LSH both shortens operating time and reduces risks, which include blood loss and damage to the bladder, ureters and bowel, when compared to a TLH.

Patients who are interested in LSH should be evaluated for malignancy or dysplasia in the uterus and cervix prior to surgery.  Patients who have a history of cervical dysplasia are not good candidates for LSH, as the treatment for recurrent dysplasia or cancer is more complicated if the uterus is absent.  A long term complication of LSH when the ovaries are retained or the patient is premenopausal is cyclic spotting from the cervical stump, which can occur in approximately 11-17% of cases. Trachelectomy (removal of the cervical stump) is sometimes required down the road for cervical dysplasia, cancer, or other persistent symptoms. 

Trachelectomy is more common in patients who have previously been treated for endometriosis.  Recurrent symptoms are an uncommon complication, so LSH is not contraindicated in patients with a history of endometriosis. 

As with any other surgery, risks versus benefits and each patient’s individual history and desires must be considered when choosing the most appropriate type of hysterectomy.  Laparoscopic hysterectomy certainly offers many benefits in regard to reduced risks and faster recovery, which are desired by many patients.