58541 Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less

Name of the Procedure:

Laparoscopy, Surgical, Supracervical Hysterectomy for Uterus 250 g or Less
Common Name: Laparoscopic partial hysterectomy

Summary

A laparoscopy, surgical, supracervical hysterectomy is a minimally invasive surgical procedure that involves removing the uterus while leaving the cervix intact. The procedure is typically performed when the uterus is 250 grams or less in weight.

Purpose

This procedure addresses various gynecological issues such as fibroids, severe endometriosis, chronic pelvic pain, uterine prolapse, or abnormal uterine bleeding. The goal is to relieve symptoms related to these conditions, improve the patient's quality of life, and prevent future gynecological problems.

Indications

• Persistent pelvic pain unresponsive to other treatments
• Large fibroids or multiple fibroids causing symptoms
• Heavy or irregular menstrual bleeding
• Endometriosis not improved with medical treatments
• Uterine prolapse

Preparation

• Patients are typically required to fast for 8-12 hours before the procedure.
• Pre-operative testing may include blood work, imaging studies like ultrasound or MRI, and a complete medical evaluation.
• Patients should discuss any medications they are taking with their doctor; some medications may need to be adjusted or stopped before surgery.

Procedure Description

1. Under general anesthesia, small incisions are made in the abdomen.
2. A laparoscope (a thin tube with a camera and light) is inserted to guide the surgeon.
3. Specialized surgical instruments are used to detach the uterus from surrounding tissues while leaving the cervix intact.
4. The uterus is then removed through the small abdominal incisions.
5. Incisions are closed with sutures or surgical glue.

Duration

The procedure typically takes 1.5 to 2.5 hours, depending on the complexity and patient-specific factors.

Setting

The procedure is usually performed in a hospital or an accredited outpatient surgical center.

Personnel

• Surgeon (usually a gynecologist specialized in minimally invasive techniques)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common: Infection, bleeding, postoperative pain, and adhesions (scar tissue formation).
• Rare: Injury to surrounding organs (such as bladder or intestines), blood clots, complications from anesthesia, and the need for a more extensive surgery.

Benefits

• Minimally invasive approach with smaller incisions, leading to quicker recovery time and less postoperative pain.
• Preservation of the cervix may help maintain sexual function and support pelvic structures.
• Relief from symptoms associated with the removed uterus.

Recovery

• Patients can often go home the same day or within 24 hours.
• Recovery time is generally 2 to 4 weeks.
• Follow-up appointments are required to monitor healing.
• Patients should avoid heavy lifting, strenuous activities, and sexual intercourse for 4 to 6 weeks post-surgery.

Alternatives

• Medical Management: Medications like hormonal therapy to manage symptoms.
• Other Surgical Options: Total abdominal hysterectomy, vaginal hysterectomy, or myomectomy (removing fibroids only).
• Non-Surgical Options: Uterine artery embolization, endometrial ablation.

Pros and Cons: Laparoscopic supracervical hysterectomy typically involves a shorter recovery time and less postoperative pain compared to abdominal hysterectomy but leaves the cervix, which might still require monitoring for cervical health issues.

Patient Experience

Patients may experience postoperative pain, which is manageable with prescribed pain medications. Some bloating or gas due to the use of gas to inflate the abdomen during surgery is normal. Most patients can resume normal activities within a few weeks, adhering to doctor's restrictions on activities and follow-up care plans.