What exactly is Laparoscopic Hysterectomy?

Laparoscopic hysterectomy is removal of the uterus through small incisions on the abdominal wall. Hysterectomies can either be partial or total. A total hysterectomy means that we are removing the uterus, cervix, fallopian tubes and ovaries. A partial hysterectomy implies that we are not removing either the cervix or the ovaries or both. Laparoscopic hysterectomy has the benefit of having a shorter hospital stay and recovery with less pain due to smaller incisions. Laparoscopic assisted Vaginal Hysterectomy is done when we are removing the cervix. Laparoscopic Supracervical Hysterectomy is done when we are leaving the cervix in place. Ovaries can be removed with either type of laparoscopic hysterectomy.

Who is not a candidate for Laparoscopic Hysterectomy?

If you have an indication for hysterectomy, the majority of the time, you are a candidate for laparoscopic hysterectomy. Only if the uterus is too large that it obstructs the ability to see around it, or if there is scar tissue that limits the ability to see or operate safely, would you not be a candidate for Laparoscopic Hysterectomy.

How is Laparoscopic Hysterectomy performed?

In the hospital, under general anesthesia, three small (1 cm) incisions are made on the abdomen, one near the belly button and the others on the right and left side of the lower abdomen. A needle is placed into the abdomen and we fill the abdominal cavity with CO2 gas so that we can see. Trocar ports, or plastic tubes, are place through the incisions. A camera is placed through the belly button incision and laparoscopic instruments are placed through the other two ports to do your surgery. If you are having your cervix removed, this can either be done laparoscopically through the small incisions or vaginally. If you are leaving your cervix in place, an incision is made above the cervix to remove the uterus and a surgical device called a morcellator will be used to remove the uterus in pieces.

Why would I leave my cervix in place?

Supracervical hysterectomy has several benefits. The cervix has supportive ligaments that will help keep the vagina and bladder in place. In addition, there is some that that if a woman feels orgasm more centrally, rather than near the clitoral region, that the cervix may play a role in orgasm. Large studies have not consistently supported this claim. If you leave your cervix in place, you will still need to have yearly pap smears to test for cervical cancer and you may have a small amount of cyclic monthly bleeding from a small amount of endometrium that may remain with the cervix. There is some evidence that leaving the cervix in place also shortens recovery time.

Why would I leave my ovaries?

Ovaries function to produce hormones. If we remove the ovaries, we are, in effect, creating a “surgical menopause”. If you are postmenopausal, there is no reason to leave your ovaries in place and we would recommend consideration of removal to minimize the risk of future ovarian cancer which is hard to detect early. If you are pre-menopausal and your ovaries appear normal, we will often recommend we leave the ovaries in place to minimize the side effects associated with menopause such as hot flushes, mood changed, vaginal dryness. If you are perimenopausal and already experiencing a lot of these symptoms, then it would be a personal choice to leave the ovaries or remove them.

How many laparoscopic hysterectomies has Dr. Martinez performed?

Dr. Martinez trained at St. Joseph Hospital in Houston from 1992-1996 and received extensive laparoscopic training in hysterectomies as well as all laparoscopic surgeries including treatment of fibroids, ovarian cysts, endometriosis and pelvic pain. Dr. Martinez performs the majority of her hysterectomies laparoscopically due to the optimized 2-4 week recovery time and overnight hospital stay associated with laparoscopic hysterectomy. Abdominal hysterectomy requires, on average, a three day postoperative stay with a 6-8 week recovery. Dr. Martinez tries to avoid hysterectomy whenever possible by utilizing alternative, minimally invasive procedures, such as her in- office Thermachoice Endometrial Ablation. However, when hysterectomy is indicated, Dr. Martinez is an extremely experience surgeon in this technique and has performed over 500 laparoscopic hysterectomies to date.

When is hysterectomy indicated?

Hysterectomy is indicated for treatment of heavy bleeding, painful periods, fibroids, endometriosis, recurrent ovarian cysts, endometrial hyperplasia, recurrent abnormal pap smears, and uterine cancer.

Please call our office today to schedule a consultation at 505-988-4922.