The Total Laparoscopic Hysterectomy (TLH) offers women an option that is far less invasive than other surgical approaches. The need for a hysterectomy is an important and difficult decision. The surgical removal of the uterus can be lifesaving for those suffering from gynecological cancers or the severe pain and heavy bleeding due to fibroids or endometriosis. Today, there are several surgical approaches that are far less invasive than a total abdominal hysterectomy, which is still widely performed. Using a laparoscope — a slender, fiber-optic tube equipped with a miniature camera, lights and surgical instruments — surgeons have the ability to see inside the abdomen and technical access to the uterus, ovaries and fallopian tubes without having to make a large incision. In the past few years, many gynecologists have performed a portion of the hysterectomy using a laparoscope. Called a laparoscopically assisted vaginal hysterectomy (LAVH), the procedure requires an incision deep within the vagina, through which the uterus and related organs are removed. The LAVH still involved a transvaginal approach and decreased healing time, similar to a total vaginal hysterectomy. With advanced laparoscopic skills, gynecological surgeons are able to perform TLH. The surgery is completed utilizing only four tiny abdominal incisions of 5 to 10 mm in length. Even a large uterus can be removed laparoscopically using this technique. A traditional open hysterectomy requires an abdominal incision of 10 to 20 cm. Post surgically, patients have a much quicker recovery, usually going home the same day or stay one overnight in the hospital. Often, patients are able to return to their normal routine in one to two weeks. Patients report less pain, minimal post-surgical narcotic pain medication use, and a faster recovery time than women undergoing abdominal hysterectomies who usually require a three to four day hospitalization and lengthy recovery time of usually six to eight weeks. The majority of hysterectomies are performed for benign tumors or conditions that allow women a choice of a variety of alternative treatments for fibroids, endometriosis and uterine prolapse.
Myomectomy is a treatment option if you have anaemia and pain or pressure is not relieved with medications. Myomectomy is also done if the fibroids have changed the uterus so as to cause infertility or repeated miscarriages, as this method improves your chances of becoming pregnant even after the procedure. After myomectomy surgery, your pelvic pain and bleeding from fibroids is reduced and your chances of having a baby is improved. If the fibroids are large and are in more numbers they can re-grow after surgery. This procedure is a preferred option to remove fibroids of varying sizes .We are able to remove even large size fibroids up to 10 – 15 cm via the tiny laparoscopic holes after morcellation . The possible complications of myomectomy include infection, scar tissue formation, damage to the bladder or bowel, and rupture of the uterine scars in late pregnancy or during labour. Rarely a myomectomy causes uterine scarring that can lead to infertility. Complete removal of any number of fibroids are usually possible via laparoscopy .However, the very tiny deep fibroids of less than 1cm , may not be easily removed by this technique. In this case, the tactile feel of the fibroids while doing the open technique, would only help to identify this tumors and remove it . Because fibroids can grow back, women those who are planning to become pregnant in the future must try to conceive as early as possible after the myomectomy procedure. However, following surgery, your doctor will advise you to wait for 2 to 3 months until the uterus heals.