Name of the Procedure:

Laparoscopy, surgical, with total hysterectomy, for uterus 250 grams or less

Summary

Laparoscopic hysterectomy is a minimally invasive surgical procedure to remove the uterus using small incisions and a camera-guided technique. It involves the complete removal of the uterus and is typically performed when the uterus weighs 250 grams or less.

Purpose

This procedure is performed to address various gynecological conditions such as fibroids, endometriosis, chronic pelvic pain, or uterine prolapse. The goal is to alleviate symptoms, improve quality of life, and, in some cases, treat or prevent certain cancers.

Indications

• Chronic pelvic pain
• Heavy or irregular menstrual bleeding unresponsive to other treatments
• Uterine fibroids
• Endometriosis
• Uterine prolapse
• Certain gynecologic cancers
• When the uterus weighs 250 grams or less

Preparation

• Patients may be required to fast for 8-12 hours prior to the procedure.
• Medication adjustments may be necessary, especially for blood thinners.
• Preoperative diagnostic tests like blood work, pelvic ultrasound, or MRI may be required.
• Bowel preparation may be instructed.

Procedure Description

1. Small incisions are made in the abdomen.
2. A laparoscope (a thin tube with a camera) is inserted through one of the incisions.
3. Surgical instruments are inserted through other incisions to remove the uterus.
4. The uterus is detached from the surrounding structures and removed through the incisions or vagina.
5. Surgical sites are closed with sutures or adhesive.

• Equipment: Laparoscope, surgical instruments, camera system.
• Anesthesia: General anesthesia is administered for the procedure.

Duration

The procedure typically takes between 2-3 hours.

Setting

Performed in a hospital or surgical center.

Personnel

• Surgeon (gynecologist specialized in minimally invasive surgery)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs (bladder, bowel)
• Blood clots
• Adverse reactions to anesthesia
• Scar tissue formation
• On rare occasions, conversion to open surgery may be necessary

Benefits

• Relief from chronic pain and heavy bleeding
• Resolution of symptoms associated with fibroids and endometriosis
• Shorter recovery time compared to open surgery
• Lower risk of complications

Recovery

• Initial recovery in the hospital (1-2 days).
• Full recovery typically takes 4-6 weeks.
• Post-procedure instructions include avoiding heavy lifting and strenuous activities.
• Pain management through prescribed medications.
• Follow-up appointments to monitor recovery and address any concerns.

Alternatives

• Medication management (hormonal treatments, pain relief)
• Uterine fibroid embolization
• Endometrial ablation
• Myomectomy (removal of fibroids only)
• Watchful waiting (monitoring condition without immediate intervention)

Each alternative has its pros and cons which should be discussed with a healthcare provider.

Patient Experience

• Patients may feel discomfort or mild pain immediately following the procedure.
• Pain and discomfort are managed with medication.
• Some patients experience minor bloating or shoulder pain due to the gas used during laparoscopy.
• Most patients can resume normal activities within a few weeks according to medical advice.