May 2009
M	T	W	T	F	S	S
« Apr		Jun »
	1	2	3
4	5	6	7	8	9	10
11	12	13	14	15	16	17
18	19	20	21	22	23	24
25	26	27	28	29	30	31

LAPAROSCOPICALLY ASSISTED HYSTERECTOMY

Posted under Women's Health by admin

Surgeons gain access to, and remove, one or more of the reproductive organs in a number of ways. This is the basis for another method of classifying hysterectomy.

In recent years, another technique has been developed that combines elements of both the abdominal and vaginal approaches. It entails using the laparoscope, described in chapter 3, to gain access to the abdomen through several small (about 1 cm) pelvic incisions. The laparoscopic view of the inside of the abdomen is transmitted to a video screen and the surgeon manipulates cutting, burning or laser instruments within the pelvis according to what is seen on the screen. Direct vision laparoscopy tends to be used only when perception of depth is unclear, otherwise all surgery is performed while watching the screen.

After detaching the uterus and any other organs to be removed with diathermy, and closing blood vessels and realigning tissues using staples or sutures, the surgeon makes an incision near the top of the vagina where it meets the cervix. The unwanted tissue is then extracted through the opening in the vagina. This technique is called laparoscopically assisted hysterectomy or laparova-ginal hysterectomy. It has now been carried out on hundreds of women who would otherwise have had an abdominal hysterectomy. Laparoscopically assisted hysterectomy requires special equipment and a team of doctors and nurses skilled in gynaecological laparoscopy. It is considered to be suitable when:

• fibroids are of intermediate size

• endometriosis is a major reason for the surgery

• a reduced recovery period is important

• there is an early stage endometrial cancer and the ovaries are to be removed.

Margaret had a laparoscopically assisted hysterectomy instead of an abdominal or vaginal hysterectomy largely because of business pressures. A senior staff member of a company involved in a takeover bid, she was appreciative of the shorter hospital stay (one to four days instead of seven to ten days) and the reduced period of convalescence (one to four weeks instead of up to two or more months). After her convalescence it took her another few months to regain total well-being, but nevertheless she was able to contribute meaningfully at a critical time in her company’s business operations.

There is some evidence that laparoscopically assisted hysterectomy has a lower complication rate than either vaginal or abdominal hysterectomy, although this claim has been disputed and the results of clinical trials are awaited with interest. The operation takes somewhat longer to carry out than the other types of hysterectomy (one to two hours on average, although the French have reduced their operating time to less than an hour, compared with thirty minutes to an hour for an abdominal hysterectomy) and requires more costly instruments.