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Gynaecology - Total Laparoscopic Hysterectomy (TLH)

Home Gynaecology – Total Laparoscopic Hysterectomy (TLH)

Introduction

A hysterectomy is a surgery that is performed to remove the uterus as a whole. It is usually performed when all other types of treatment fail. Sometimes, the cervix, fallopian tubes, and ovaries would also have to be removed. A complete hysterectomy is one where the entire uterus is removed, including the body, fundus and cervix.

The patient has a choice regarding keeping the cervix if it is healthy. Doctors prefer laparoscopic procedures compared to open abdominal surgeries as it assures shorter recovery time and fewer complications.

The ovaries (oophorectomy), fallopian tubes (salpingectomy) along the uterus and cervix are often removed only if cancer has been detected.

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What are the Types of Hysterectomies?

  • ● Subtotal Hysterectomy – Removal of the uterus
  • ● Total Hysterectomy – Removal of uterus and cervix
  • ● Radical Hysterectomy – Removal of the uterus, surrounding tissues, fallopian tubes, ovaries, lymph vessels, part of the vagina

What are the Different Procedures of Performing a Hysterectomy?

  • ● Laparoscopic Hysterectomy: Uterus is removed through the abdomen
  • ● Vaginal Hysterectomy: Uterus is removed through the vagina
  • ● Abdominal Hysterectomy: Uterus is removed through the lower part of the abdomen

When Must one Consider Opting for a Hysterectomy?

  • Endometriosis: This is a condition where the endometrium tissue that lines the inside of the uterus also grows on the outside which causes pelvic pain and irregular menstruation
  • Cancer: Be it ovarian, uterine, cervical, or cancer of the fallopian tubes
  • ● Pelvic pain that is acute or chronic
  • Thickening of the uterus or adenomyosis: This is a condition wherein the uterus lining becomes thick and the endometrial tissue grows into the deeper layers of the uterus
    Prolapse of the uterus: In this condition, the floor of the uterus loses its strength and causes the uterus to move into the vaginal tract
  • Fibroids: Benign tumours which can cause severe pain and excessive bleeding
  • Transgender affirmation: Sex change surgeries due to gender dysphoria
  1. Heavy periods
  2. Pelvic Inflammatory Disease
  3. Postpartum: in case of complications
  4. Dysfunctional Uterine Bleeding
  5. Septic Abortions
  6. Obstetric complications
  7. Preventative measures against cancer

What is a Total Laparoscopic Hysterectomy?

A Total Laparoscopic Hysterectomy (TLH) is a laparoscopic surgery performed to remove the womb and cervix. This is a procedure managed by the insertion of scopes, which are laparoscopes. These are tiny telescope instruments that are introduced into the abdomen through small incisions. The scopes have cameras, and the other scopes are manipulated into performing the surgery. This also allows the surgeon to explore the entire pelvis and abdomen for any other abnormalities which, if they do arise, can be treated surgically then and there.

How is the Total Laparoscopic Hysterectomy Performed?

This is a major surgery performed using laparoscopes which make incisions into the abdominal wall to reach the uterus. A small incision is first made near the umbilicus. The number of scopes inserted varies, depending on the severity of the condition. The abdomen is filled with carbon dioxide to create more visual space for the surgeon. The ligaments holding the uterus are slowly cut and blood vessels are ligated. The uterus is removed via the vagina by making an incision at the top part of the vagina. This incision is made with dissolvable stitches. All blood vessels in the area are cauterised to prevent any bleeding. If the uterus is too big, it is sometimes cut up into smaller portions and then removed by each part. All the incision sites are then closed up with stitches.

The procedure usually takes around two hours. Post the surgery, the patient will experience pain. The abdominal pain should subside hopefully. There is a correction in the bleeding that occurs.

  • Since this is a surgery that involves the removal of the uterus through the vagina, there are some prerequisites:
  • ● The uterus must be of a certain size and cannot be too large to remove via passage through the vaginal canal
  • ● If cancer is the cause for surgery, then the spread of cancer must be determined to prevent the seeding of cancer cells

What are the Possible Complications in TLH?

  • ● Injury to other parts of organs or organs themselves
  • ● Infections despite post-operative prophylactic antibiotics
  • ● Injury to blood vessels
  • ● Spread of cancer by seeding of cancerous cells
  • ● Heavy loss of blood
  • ● Formation of blood clots or hepatomas
  • ● Deep vein thrombosis where a clot can develop in the leg and can be fatal if not treated early
  • ● Stroke leading to paralysis of any kind
  • ● Painful intercourse
  • ● Weakness in lower limbs
  • ● Cuff Dehiscence means that the skin at the top part of the vagina separates causing hernias and bleeding
  • ● Urinary incontinence
  • ● Vaginal Prolapse where the vagina or a part of it exits the body
  • ● Formation of fistulas
  • ● Bleeding of the bladder
  • ● Bleeding of the intestines

What are the Postoperative Care in TLH?

  • ● Hormonal replacement therapy due to menopause caused by surgery
  • ● Rest
  • ● Restriction from living heavy objects to allow for muscles and tissues to heal
  • ● Clean surgical sites

A Hysterectomy can be a choice or a necessity. Proper medical care, counselling and treatment is important before proceeding with it. There are many complications. Thus, post-operative care and recovery are extremely important.

 

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