Laparoscopic hysterectomy: your frequently asked questions answered

Hysterectomy is a procedure in which the uterus is removed, commonly done to treat fibroids or heavy periods. Laparoscopic hysterectomy has several advantages over open surgery, as explained by leading laparoscopic surgeon and consultant gynaecologist Mr Chellappah Gnanachandran in our latest article.

I need a hysterectomy for heavy bleeding due to fibroids and adenomyosis: why should I consider laparoscopic hysterectomy instead of open hysterectomy?

If a woman has relatively small fibroids, and also suffers from adenomyosis which is when the lining of the womb grows into the muscles, they can experience heavy periods and pelvic pain. Sometimes they can suffer endometriosis as well.

When we perform a laparoscopic surgical procedure, we can get a thorough assessment of the situation, and then decide if a complete hysterectomy will be carried out. This procedure is associated with minimal scarring and minimal post-operative pain. Open hysterectomies are associated with much more chronic pain and post-operative recurring pain.

We generally recommend avoiding open hysterectomy if it is at all possible and opting for a keyhole hysterectomy instead.

What are the benefits of laparoscopic hysterectomy compared to open surgery?

Open hysterectomy is mainly done if it’s suspected the patient has ovarian cancer, if they have large fibroids (15 centimetres), or possible malignancies such as sarcoma.Otherwise, almost all hysterectomies are done by laparoscopic surgery. This is because patients recover much faster from laparoscopic surgery. They can usually go home the same day as the surgery, and are usually working without any pain after two or three days. There are also fewer complications in high BMI patients such as blood clots in the legs.

Should the cervix be removed during the hysterectomy?

If the patient has chronic pelvic pain after sex, this is usually pain coming from the cervix. In this situation, it is better to have the cervix removed.

A long-term benefit of having the cervix removed is that if the woman needs hormone replacement therapy in the future, they will only need one hormone. If the cervix is not removed, then the patient will need two hormones: oestrogen and progesterone.

However, there are a couple of problems. There is a widespread belief that removing the cervix can negatively impact sexual pleasure, but this has not been proven.

Another problem is the belief that removing the cervix can increase the chances of prolapse. However, most scientific studies have discredited this belief.

Should the ovaries be removed during a hysterectomy?

In women younger than 45, unless they have severe endometriosis it is better to leave the ovaries. This means they won't need hormone replacement and their life satisfaction is generally better. But in patients who have significant endometriosis, or are above 50 years of age, it is better to remove the ovaries. If the patient has a higher risk of developing ovarian cancer, such as a family history of the disease, the ovaries are usually removed. The patient then typically undergoes hormone replacement therapy, which lessens the risk of developing breast cancer.

What is the recovery period like after a laparoscopic hysterectomy?

After a laparoscopic hysterectomy, some patients might stay overnight, but most go home the same day. We make sure they pass urine twice before they go home. Over the night they can expect a little pain and bleeding. They usually take painkillers and must drink a lot of water.

If they go home on the same day as the surgery, we call them the following morning to make sure they have passed urine and aren’t experiencing significant pain. We also remind them to take any medication they have been prescribed.  

Patients are usually able to do day-to-day work in their home, such as cooking and cleaning around 3 to 5 days after the surgery.

Patients must let us know if they are experiencing bleeding, significant pain, fever or vomiting in the weeks following the surgery. However, most patients have fully recovered and can return to their daily lives within four weeks.