Laparoscopic Hysterectomy

What Is Closed Uterine Surgery (Laparoscopy)?

Laparoscopy is a technique performed under general anesthesia, in which a camera (laparoscope) and thin, long surgical instruments are inserted through small incisions in the abdomen (usually 0.5-1 cm in size) to visualize the internal organs and perform surgery. During the procedure, the abdomen is inflated with carbon dioxide gas so that its interior can be seen clearly. The surgeon performs the operation by watching the magnified image projected onto a screen by the camera.

Laparoscopic Hysterectomy, on the other hand, is the removal of the uterus using this closed method. There are different types of laparoscopic hysterectomy:

• Total Laparoscopic Hysterectomy (TLH): The entire uterus and cervix are freed laparoscopically from within the abdomen and are usually removed through the vagina. It is one of the most commonly performed types.
• Laparoscopic Supracervical Hysterectomy (LSH): Only the body of the uterus is removed, while the cervix is left in place. This is a less commonly preferred method.
• Laparoscopically Assisted Vaginal Hysterectomy (LAVH): Part of the operation (such as cutting the ligaments and blood vessels of the uterus) is performed laparoscopically, while the uterus is then removed through the vagina.

In addition, the term “closed uterine surgery” can sometimes also cover procedures such as laparoscopic myomectomy (removal of myomas by a closed method, with the uterus preserved) or laparoscopic endometriosis surgery, which also affects the uterus. However, its most common use refers to laparoscopic hysterectomy.

Why Is Closed Uterine Surgery (Laparoscopic Hysterectomy) Performed? (Indications)

Hysterectomy, meaning the removal of the uterus, is a significant decision and is generally performed when other treatment methods have failed or are not suitable, in problems that seriously affect the patient’s quality of life, or in certain cancer cases. The laparoscopic method allows this surgery to be performed more comfortably. The main reasons for hysterectomy are as follows:

• Treatment-Resistant Abnormal Uterine Bleeding: Severe, prolonged, heavy menstrual bleeding that leads to anemia and does not respond to medication or other treatment methods (usually due to myomas or adenomyosis).
• Symptomatic Myomas: Large, numerous myomas, or those causing severe pain, bleeding, or pressure symptoms (especially in patients who do not wish to have children or for whom myomectomy is not suitable).
• Endometriosis and Adenomyosis: Advanced-stage endometriosis or adenomyosis (implantation of endometrial tissue within the uterine muscle) causing severe pain that does not respond to medication or other surgical methods, or affecting other organs (in patients who do not wish to have children).
• Pelvic Organ Prolapse (Uterine Prolapse): Especially in advanced cases of uterine prolapse, hysterectomy may sometimes be performed together with other corrective surgeries.
• Chronic Pelvic Pain: Chronic, severe pelvic pain believed to be related to the uterus that does not respond to any other treatment methods.
• Uterine (Endometrial), Cervical, or Ovarian Cancers: Hysterectomy is usually an important part of treatment for cancers of these organs (the extent of surgery varies depending on the type and stage of the cancer and is usually performed by Gynecologic Oncologists).
• Precancerous Lesions: In cases of atypical complex hyperplasia in the endometrium (uterine lining) or recurrent or advanced precancerous cervical lesions (such as CIN III), hysterectomy may be an option, especially in patients who do not wish to have children.

The decision to have a hysterectomy must be made carefully, particularly for women of reproductive age, because of its irreversible consequences (loss of menstruation, inability to become pregnant), and all alternatives should be discussed with the patient.

What Are the Advantages of Closed (Laparoscopic) Surgery Over Open Surgery?

Laparoscopic hysterectomy offers significant advantages over traditional open abdominal surgery (laparotomy):

• Smaller Scars: Instead of one large surgical scar on the abdomen, only a few small scars, usually 0.5-1 cm, remain. This is better cosmetically and also reduces the risk of wound-related problems such as hernia.
• Less Postoperative Pain: Because of the smaller incisions and less tissue trauma, postoperative pain is noticeably less, and fewer painkillers are needed.
• Shorter Hospital Stay: Patients can usually be discharged within 1-2 days after surgery, whereas this period can be 3-5 days or longer with open surgery.
• Faster Recovery and Return to Daily Life: Patients can return to their normal daily activities and work in a much shorter time (usually within 2-4 weeks). With open surgery, this period can extend to 6-8 weeks.
• Less Blood Loss: Because blood vessels can be visualized and controlled better with the laparoscopic method, blood loss during surgery is generally lower.
• Lower Risk of Infection: Because the wound is smaller and the inside of the abdomen has less contact with the outside environment, the risk of infection is lower.
• Lower Risk of Intra-Abdominal Adhesions: The risk of adhesions forming between abdominal organs after surgery may be lower than with open surgery.

For these reasons, laparoscopic hysterectomy is now frequently the preferred method in suitable patients.

How Is Closed Uterine Surgery (Laparoscopic Hysterectomy) Performed? Step-by-Step Process

The laparoscopic hysterectomy procedure is generally performed as follows:

1. Anesthesia: After the patient is taken to the operating room, general anesthesia is usually administered.
2. Preparation: The surgical area is sterilized, the patient is positioned appropriately, and a urinary catheter may be inserted.
3. Gas Insufflation: A special needle (Veress needle) or trocar is inserted into the abdominal cavity, usually through a small incision made at or just below the navel, and the abdomen is inflated with carbon dioxide (CO2) gas (pneumoperitoneum). This separates the organs from one another and provides a better view and working space.
4. Camera Placement: After the gas is introduced, the camera system (laparoscope) is inserted into the abdomen, either through the same incision or a different one. The camera projects a magnified image of the interior of the abdomen onto a video monitor.
5. Placement of Other Instruments: Usually 2-3 additional smaller incisions (5-10 mm) are made in the lower abdomen or on the sides. Laparoscopic surgical instruments (graspers, scissors, energy devices such as cautery, ultrasonic cutters, etc.) are inserted into the abdomen through these incisions.
6. Freeing the Uterus: The surgeon uses these instruments while watching the image on the monitor. The ligaments holding the uterus in place and the blood vessels supplying it are carefully identified, cut using special energy devices, and simultaneously sealed to control bleeding. Whether the ovaries and/or fallopian tubes will be removed is determined according to the preoperative plan, and if necessary, they are freed as well.
7. Removal of the Uterus: The freed uterus (and cervix) is usually removed through the vagina. If the uterus is too large or removal through the vagina is not suitable, it can be removed through one of the abdominal incisions after being cut into smaller pieces inside a special bag (morcellation).
8. Final Checks and Closure: After the uterus is removed, the abdomen is checked again for any bleeding. Additional bleeding control is performed if necessary. The gas inside the abdomen is released. The instruments are removed, and the small incisions are closed with stitches or special adhesive strips.

The duration of the surgery generally varies between 1 and 3 hours, depending on the size of the uterus, the presence of adhesions, whether additional procedures are needed, and the surgeon’s experience.

Risks and Possible Complications of Closed Uterine Surgery

While laparoscopic hysterectomy is a safe surgery in experienced hands, like any surgical procedure it carries certain risks:

• Anesthesia-Related Risks: General risks that vary depending on the type of anesthesia used.
• Bleeding: More bleeding than expected during or after surgery (this risk is generally lower than with open surgery). A blood transfusion may rarely be needed.
• Infection: Infection developing at the incision sites, inside the abdomen, or in the urinary tract (the risk is lower than with open surgery).
• Injury to Neighboring Organs: There is a risk of injury to the bladder, ureters (the channels carrying urine from the kidneys to the bladder), or intestines during surgery. This risk is rare, but in laparoscopy it may be slightly higher than with open surgery, especially if there are severe adhesions or the surgeon’s experience is insufficient. If an injury is noticed, it is repaired during the surgery.
• Vascular Injuries: Injury to major blood vessels inside the abdomen is very rare.
• Gas Embolism: A very rare condition in which the carbon dioxide gas used to inflate the abdomen enters a blood vessel.
• Blood Clotting (Thromboembolism): There is a risk of clot formation in the leg veins (DVT) or of this clot traveling to the lungs (pulmonary embolism). This risk is reduced by getting up early after surgery and, sometimes, with blood-thinning medications.
• Incisional Hernia: A hernia can rarely develop at one of the small incision sites.
• Possibility of Conversion to Open Surgery: If an unexpected situation is encountered during laparoscopy (uncontrollable bleeding, severe adhesions, organ injury) or it becomes clear that the procedure cannot be completed safely, the surgery may be converted to open surgery (laparotomy) for the patient’s safety. This rate is generally low (around 1-5%).
• Vaginal Cuff Problems (after TLH): When the cervix is also removed, the suture line at the top of the vagina may rarely open up or become infected.

Before surgery, Prof. Dr. Nuray Bozkurt will explain your specific risks and the precautions to be taken in detail.

Recovery Process After Closed Uterine Surgery

The recovery process after laparoscopic hysterectomy is noticeably faster and more comfortable than after open surgery:

• Hospital Stay: One or two nights is usually enough.
• Pain: Postoperative pain is less than with open surgery and is usually well controlled with oral or intravenous painkillers. Shoulder pain may be felt for the first few days due to residual gas in the abdomen; this is temporary.
• Mobilization: You are encouraged to get up and walk on the evening of surgery or the following morning. This speeds up recovery and reduces the risk of blood clots.
• Nutrition: Oral fluid intake is usually started shortly after surgery, and a normal diet is resumed quickly.
• Return to Daily Activities: Light housework and short walks can be resumed within a few days. More strenuous activities, returning to work, and driving are usually possible within 2-4 weeks (with your doctor’s approval).
• Heavy Lifting and Exercise: It is generally recommended to avoid heavy lifting (over 5 kg) and strenuous exercise for 4-6 weeks.
• Sexual Intercourse: Waiting 6-8 weeks is generally recommended to allow complete vaginal healing. It can be resumed after a check-up with your doctor.
• Outcomes: Since the uterus is removed, menstrual bleeding stops completely and pregnancy is no longer possible. If the ovaries are preserved (as they usually are before menopause), hormone production continues and menopausal symptoms are not experienced.

Closed Uterine Surgery in Ankara: Prof. Dr. Nuray Bozkurt’s Experience and Approach

With her experience in gynecological surgery, Prof. Dr. Nuray Bozkurt offers her patients in Ankara a modern and safe closed (laparoscopic) surgery option whenever the uterus needs to be removed:

• Expertise and Experience: She has received the necessary training and has sufficient experience in laparoscopic hysterectomy and other minimally invasive gynecological surgeries.
• Choosing the Right Method: She determines the most suitable surgical approach (laparoscopic, vaginal, or open when necessary) by evaluating the patient’s medical condition, the size of the uterus, previous surgeries, and general health status. Her priority is always minimally invasive methods.
• Safe Surgical Practice: She performs her surgeries in fully equipped, technologically advanced, and safe hospital settings in Ankara, together with experienced anesthesia and operating room teams.
• Patient-Focused Care: She informs the patient in full detail before surgery, answers questions, and addresses concerns. In the postoperative period, she provides close follow-up and support to help the patient have a comfortable recovery.
• Advantages of Minimally Invasive Surgery: She aims for her patients to benefit from the advantages offered by laparoscopy, such as less pain, faster recovery, and better cosmetic results.
• Easy Communication: She ensures that her patients can easily reach her before and after surgery (0538 983 18 78)(0312 284 00 12).

If you need surgery due to a health problem related to your uterus and would like information about closed (laparoscopic) surgical methods, you can consult Prof. Dr. Nuray Bozkurt at our clinic in Ankara. Please call us at 0538 983 18 78 to make an appointment so that we can determine the most suitable and safest surgical option for you, plan the process in detail, and answer your questions.