Name of the Procedure:

Laparoscopy, Surgical, with Total Hysterectomy for Uterus Greater than 250 g
Common name(s): Laparoscopic Hysterectomy

Summary

A laparoscopic hysterectomy is a minimally invasive surgical procedure used to remove the uterus. In cases where the uterus is larger than 250 grams, specialized techniques and tools are required. This method involves small incisions in the abdomen through which a laparoscope (a thin tube with a camera) and surgical instruments are inserted, allowing the surgeon to perform the operation with greater precision and minimal scarring.

Purpose

This procedure is performed to treat various gynecological conditions such as uterine fibroids, endometriosis, chronic pelvic pain, abnormal uterine bleeding, or gynecologic cancers. The goal of the surgery is to alleviate symptoms, prevent disease progression, and improve the patient's quality of life.

Indications

• Presence of uterine fibroids causing severe symptoms.
• Chronic pelvic pain not responding to other treatments.
• Heavy or abnormal uterine bleeding.
• Endometriosis unresponsive to medication.
• Presence of gynecologic cancers.
• Enlargement of the uterus to greater than 250 grams.

Preparation

• Patients are typically required to fast for at least 8 hours before the procedure.
• Certain medications may need to be adjusted or stopped before surgery.
• Preoperative tests such as blood work, imaging studies, and an ECG (electrocardiogram) may be necessary.

Procedure Description

1. The patient is placed under general anesthesia.
2. Several small incisions are made in the abdomen.
3. A laparoscope and other specialized surgical tools are inserted through the incisions.
4. The surgeon uses these instruments to carefully remove the uterus.
5. The removed uterus is then extracted, often through one of the small incisions.
6. The incisions are closed with sutures or surgical glue.

Duration

The procedure typically takes between 2 to 4 hours, depending on the specific case and any complications that may arise.

Setting

This surgery is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon (specializing in gynecology or minimally invasive surgery)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Damage to surrounding organs (e.g., bladder, bowel)
• Blood clots
• Complications related to anesthesia
• Scar tissue formation (adhesions)
• Rare risks include unintended injury to blood vessels or nerves

Benefits

• Relief from symptoms such as pain and heavy bleeding.
• Minimal scarring and shorter recovery time compared to open surgery.
• Reduced risk of infection and less postoperative pain.
• Improved quality of life and resolution of gynecological issues.

Recovery

• Hospital stay of 1-2 days may be necessary.
• Full recovery typically takes 4-6 weeks.
• Patients are advised to avoid heavy lifting and strenuous activities during recovery.
• Follow-up appointments are scheduled to monitor healing and address any concerns.

Alternatives

• Non-surgical treatments: Medication, uterine artery embolization, or hormonal therapy.
• Open abdominal hysterectomy: Involves a larger incision with a longer recovery period.
• Vaginal hysterectomy: Performed through the vagina, suitable for smaller uteri.
• Each alternative has its own risks and benefits, which should be discussed with the healthcare provider.

Patient Experience

• During the procedure, the patient will be under general anesthesia and will not feel pain.
• Post-procedure, some discomfort, cramping, and mild pain are common.
• Pain management will include medications and instructions for home care.
• Patients can expect a gradual return to normal activities, with full recovery generally achieved in 4-6 weeks.