A GUIDE TO KEYHOLE SURGERY IN HYSTERECTOMY

This guide has been written for women who want to find out more about hysterectomy and, in particular, the use of keyhole (laparoscopic) surgery in hysterectomy. Whilst this guide offers general information about hysterectomies and keyhole surgery, you should always discuss the details of your particular case with your GP or specialist.

Introduction

A hysterectomy involves removal of the womb or uterus and is a very common operation. In some situations the fallopian tubes and the ovaries may also need to be removed. There are a number of reasons why a woman might need a hysterectomy. These include:

• very heavy or painful periods
• fibroids (non-cancerous growths in the muscular wall of the womb)
• endometriosis, when tiny pieces of the lining of the womb become misplaced in other areas of' the body; this condition can be treated by keyhole surgery
• hormone imbalance
• prolapse (when the tissues holding the womb in place weaken and the womb slips downwards)
• loss of control in passing urine caused by prolapse of the womb
• cancer of the womb or ovary

Surgical procedures in hysterectomy

There are two ways in which the uterus can be removed, by traditional, or open surgery which is carried out through an incision in the abdomen, or by keyhole surgery where the uterus is removed through the vagina. Depending on a number of factors, your specialist will make a clinical decision on whether to perform your hysterectomy by keyhole or open surgery. It is not always possible to use keyhole surgery (for example, in the case of very large fibroids).

A hysterectomy carried out by open surgery is a major operation involving a large abdominal incision along the bikini line, which gives the surgeon direct access to the abdominal cavity. With open surgery you will usually spend about a week in hospital and need several months' convalescence.

Whichever type of surgery is used for a hysterectomy there are three main stages that take place. Firstly, the uterus is detached from the surrounding tissue. This is done either by cutting or with lasers which vaporise the tissue attachments. Next, the blood vessels going to the uterus are secured and sealed to prevent loss of blood. Finally, the uterus is removed.

Keyhole surgery

Keyhole surgery involves one or more small incisions through which special surgical instruments are passed. The surgeon is able to see inside the body using an instrument called a laparoscope. A laparoscope is a form of telescope with a powerful light source. A miniature video camera is connected to the laparoscope and this projects a clear image from inside the body onto a television screen. Viewing the operation on the monitor, the surgeon is able to manipulate the laparoscope and surgical instruments from outside the patient's body to carry out the surgical operation from within.

These days keyhole surgery (laparoscopy) is used to diagnose most gynaecological problems, as well as for a number of surgical procedures including some treatments for infertility, the removal of ovarian cysts, and emergencies such as treating an ectopic pregnancy.

To create space around the organs and to allow the surgeon a clear view, carbon dioxide gas is introduced into the abdomen. Three tiny incisions are then used in a laparoscopic hysterectomy which give access to the laparoscope and other surgical instruments. Once the uterus has been detached from the surrounding tissue and the blood vessels sealed, it is then removed through a small incision at the top of the vagina. Some surgeons refer to this technique as Laparoscopically Assisted Vaginal Hysterectomy (LAVH).

Benefits

If possible, removal of the womb via the vagina is the preferred method, as keyhole surgery offers many advantages over open surgery. These are:

• minimal scarring
• less pain
• reduced risk of infection
• faster recovery
• quicker return to normal activity

Occasionally, during an operation, the surgeon may discover an additional problem which complicates the procedure. In this situation, the surgeon will need to make a number of decisions, which might include converting from keyhole to open surgery. Ask your surgeon to explain the surgical procedure and any possible complications before your operation.