Name of the Procedure:

Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g

Summary

This procedure involves surgically removing the uterus that is larger than 250 grams. The surgery uses a laparoscope, a thin tube with a camera, inserted through small incisions in the abdomen, and the uterus is removed through the vagina.

Purpose

The procedure addresses conditions such as uterine fibroids, heavy or abnormal bleeding, severe pelvic pain, and other uterine abnormalities. The goal is to alleviate symptoms, remove disease or abnormal tissue, and improve the patient's quality of life.

Indications

• Uterine fibroids causing symptoms
• Severe abnormal uterine bleeding
• Chronic pelvic pain related to the uterus
• Uterine prolapse
• Uterine cancer
• Other uterine abnormalities

The procedure is appropriate for patients with enlarged uteri greater than 250 grams who have not responded to other treatments.

Preparation

• Fasting for at least 8 hours before the procedure
• Adjusting current medications as advised by the surgeon
• Preoperative blood tests and imaging studies (e.g., ultrasound, MRI)
• Physical examination and health history review
• Bowel preparation may be required

Procedure Description

1. Anesthesia is administered (typically general anesthesia).
2. Small incisions are made in the abdomen to insert the laparoscope and other surgical instruments.
3. The abdomen is inflated with carbon dioxide gas for better visualization.
4. The laparoscope provides a view of the pelvic organs.
5. Surgical instruments are used to detach the uterus from surrounding structures via the vaginal route.
6. The uterus is removed through the vagina.
7. The incisions are closed with sutures or surgical tape.

Duration

The procedure typically takes 2 to 4 hours.

Setting

The procedure is performed in a hospital or surgical center.

Personnel

• Gynecologic surgeon
• Surgical assistants
• Anesthesiologist
• Operating room nurses
• Surgical scrub techs

Risks and Complications

• Common: Infection, bleeding, pain, adverse reactions to anesthesia
• Rare: Damage to surrounding organs (bladder, bowel, blood vessels), blood clots, prolonged recovery, hernia at incision sites

Benefits

• Relief from symptoms such as heavy bleeding and pelvic pain
• Removal of abnormal or diseased tissue
• Improved quality of life and daily functioning
• Minimally invasive approach with generally faster recovery compared to open surgery

Recovery

• Initial hospital stay of 1-2 days
• Pain management with medications as needed
• Light activities can be resumed within a few days
• Avoid heavy lifting and strenuous activity for 4-6 weeks
• Follow-up appointment with the surgeon to monitor healing

Alternatives

• Medications (e.g., hormonal treatments)
• Non-invasive procedures (e.g., uterine artery embolization)
• Traditional open abdominal hysterectomy
• Myomectomy (removal of fibroids without removing the uterus)

Each alternative varies in terms of efficacy, recovery time, and suitability depending on the specific medical condition.

Patient Experience

Patients may feel drowsy and experience some pain or discomfort after waking up from anesthesia. Pain management will be provided. Most patients feel significantly better in a few days, with gradual improvements over the following weeks. Complete healing and return to normal activities usually take 4-6 weeks.