Dr Royal Benson, III Diplomate of the American Board of Obstetrics & Gynecology

Total Laparoscopic Hysterectomy (TLH)

Advances in surgical technology and technique have allowed for a hysterectomy to be performed with only a few small incisions. Videoscopic equipment permits an innovative new procedure that is usually called "total laparoscopic hysterectomy." Instead of a large abdominal incision or a vaginal approach requiring a significant vaginal incision and manipulation, this less invasive procedure can be performed with or without the removal of one or both ovaries and tubes.

Laparoscopy also allows for other types of surgery that may be needed at the same time, such as removal of ovarian cysts, removal of adhesions or pelvic support procedures.

This procedure is superior because it is completely accomplished through the video scope technique, and offers great benefits to patients. It usually requires only 3-5 one centimeter incisions on the abdomen and these small incisions can be covered by regular band-aids. The patient will have almost no bleeding during surgery, significantly less pain post-operatively, decreased risk of complications and a more rapid return to normal activities.

Under optimal conditions, on average, my patients are in the hospital for less than 24 hours. These women are usually driving a car within 3-4 days after surgery and are ready to return to work in 10-14 days. In fact, there are women in my private practice that have returned to work in three days! These women are not the norm and I do not encourage such a rapid return to work or normal activity, but it is testimony to the simple recovery experienced by some.

With traditional hysterectomy procedures, whether abdominal or vaginal, recovery times are much longer and seem to be more stressful. The abdominal hysterectomy entails a hospital stay of 2-4 days and requires the woman to refrain from strenuous activity or work for six weeks or more.

Women contemplating a hysterectomy must consider their childbearing complete. They should also believe that if they keep their uterus, it will be a source of heavy bleeding, a continued source of pain, and a cause of discomfort with sexual relations. A woman is a candidate for having her uterus removed laparoscopically if she meets a few simple criteria. Diabetes and high blood pressure must be under control, and cardiovascular health is of utmost importance. The candidate should also be mentally prepared. The stress of anesthesia and surgery will take a greater toll if the patient is not emotionally stable prior to surgery.

Most hysterectomies can be done laparoscopically, and ideal conditions exist if there is minimal or no scarring from previous surgery, no bowel adhesions and no evidence of bowel or bladder-causing problems.

Ultimately, the size of the uterus may be the greatest factor in determining which surgical approach to use. A uterus that is the size of a pregnant uterus at 14 weeks or the size of a large grapefruit, can easily be removed with the laparoscope. A uterus that is greater than12-14 week size can be attempted laparoscopically, but may require additional pre-surgical planning.

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