Laparoscopic Hysterectomy

Laparoscopic Hysterectomies are done using an instrument known as a laparoscope (a tube with a lighted camera) and surgical tools inserted through small abdominal incisions. Ever since the first laparoscopic hysterectomy was reported in 1989, there’s been a trend to change the approach to hysterectomy from the open abdominal to a laparoscopic technique to reduce hospital stay, recovery time, scarring and risks. “Lap hystos” may be the most common hysterectomy procedures used for trans men.

The two most widely used types of Laparoscopic Hysterectomy are Total Laparoscopic Hysterectomy (TLH) and Laparoscopically-Assisted Vaginal Hysterectomy (LAVH.)

Total Laparoscopic Hysterectomy

Total Laparoscopic Hysterectomy (TLH) is a minimally invasive procedure which removes the reproductive organs through small abdominal incisions.

• The patient is put to sleep with general anaesthetic.
• The abdomen is inflated with CO2 gas to improve visibility of the organs.
• A laparoscope is placed through a 5-6 mm incision in the belly button and the images of the internal organs are displayed on an HD screen.
• Two or three other small incisions are made on the abdomen and are used to insert surgical instruments.
• The surgeon cuts the organs into smaller pieces and removes them through the incisions.

Surgery time is approximately 2 hours. Patients may be released from the hospital on the same day as surgery, or stay for one night.

Recovery time is about 2 weeks. More strenuous physical activities can be resumed in about 6-8 weeks.

The advantages of TLH are decreased blood loss, smaller incisions, shorter hospital stay, faster recovery time and fewer abdominal wall infections when compared with Abdominal Hysterectomy.

Laparoscopically-Assisted Vaginal Hysterectomy

Laparoscopically-Assisted Vaginal Hysterectomy (LAVH) is procedure that combines TLH and Vaginal Hysterectomy. With LAVH, a laparoscope and surgical tools are inserted through small abdominal incisions and organs are removed from a small incision at the top of the vagina.

Patients with enlarged organs or fibroids or vaginal atrophy are not good candidates for LAVH.

Recovery time is a bit longer than TLH, about 3-4 weeks.

Abdominal Hysterectomy

With Abdominal Hysterectomy, reproductive organs are removed through a 5-7 inch incision in the abdominal wall (laparotomy.) A horizontal incision is more common but a vertical incision is used in cases of endometriosis, large fibroids, a large uterus, or cancer. The incision cuts through the skin, connective tissues, and abdominal muscle.

Surgery time is approximately 1-2 hours. Patients stay in the hospital for 3-5 days.

Recovery time is about 6-8 weeks. More strenuous physical activities can be resumed in 3-6 months.

Vaginal Hysterectomy

Vaginal Hysterectomy is surgical procedure to remove reproductive organs through an incision in the vagina. The top of the vagina is closed using dissolvable stitches. A dressing may be left in the vagina to apply pressure and stop bleeding.

Surgery time is approximately 1-2 hours. Patients stay in the hospital for 3-5 days.

Recovery time is about 6-8 weeks. More strenuous physical activities can be resumed in 3-6 months.

Vaginal Hysterectomy can only be done when the organs being removed are small enough to pull through the vagina. Removal of the ovaries is not always possible using this method.

An advantage of Vaginal Hysterectomy is that there is no visible scarring. It also has a faster healing time and less pain than Abdominal Hysterectomy. However, because the surgeon is operating through the vagina they can’t see the organs very well, so there’s a heightened risk of accidental internal injury