Total Laparoscopic Hysterectomy with Bilateral Salpingo-Oophorectomy

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Total Hysterectomy refers to a major surgical procedure that involves the complete removal of the uterus and cervix, laparoscopic refers to the method of surgery. In the Laparoscopic method, several small incisions are used as opposed to abdominal surgery, which involves one large incision. This ensures less scarring and is a less invasive procedure. Bilateral Salpingo-Oophorectomy refers to the surgical procedure in which both ovaries and fallopian tubes are removed from the body. Overall, Total Laparoscopic Hysterectomy with Bilateral Salpingo Oophorectomy is simply the surgical removal of the uterus, cervix, fallopian tubes and, ovaries.

If a patient is considering Total Laparoscopic Hysterectomy with Bilateral Salpingo Oophorectomy, it is important to consider all the factors that come with this major surgical procedure. There are several variations of Hysterectomy, the base form being the removal of only the uterus. Discussing with your doctor about which procedure is best suited to your situation is vital.

There are several conditions or reasons that might prompt a Total Laparoscopic Hysterectomy with Bilateral Salpingo-Oophorectomy, detailed below are some of them:

  1.    Uterine Fibroids: Symptomatic uterine fibroids, which cause excessive bleeding, pain, and discomfort
  2.    Uterine prolapse: This occurs when the uterus moves into the vaginal canal due to the weakening of the tissues and ligaments that support it.
  3.    Cancer: Cancer could be of the uterus, cervix or ovaries. At advanced stages of cancer, a total hysterectomy may be the only option.
  4.    Abnormal vaginal bleeding which has not been alleviated through other procedures such as Myomectomy or Dilation and curettage.
  5.    Chronic pelvic pain
  6.    Pelvic inflammatory disease: This is a bacterial infection that can damage the womb and fallopian tubes if left untreated. This can cause long term effects; Total Laparoscopic Hysterectomy with Bilateral Salphingo Oophorectomy is a solution for this.
  7.    Endometriosis: This is a disorder that causes the endometrium tissue, which normally only lines the inside of the uterus to grow outside of it. Commonly in the ovaries, fallopian tubes or pelvic tissues. This is a painful disorder, and a hysterectomy can alleviate this pain. Although it should be taken into note that after hysterectomy a woman cannot have children.
  8.    Adenomyosis: This is a condition where the tissue growing inside the womb begins to grow within the muscular wall of the womb as well. This can cause considerable pain; a Hysterectomy can cure this.
  9.    Ovarian Mass: A tumour, cyst or an abscess that may apply pressure to nearby organs and cause discomfort or pain.
  10.    Ectopic pregnancy: This condition occurs when the fertilized embryo is implanted outside the uterus, it may implant into the fallopian tube and the full procedure may be the ideal solution.

Prior to the surgery, patients may have to fast for a certain period of time. Doctors may provide specific guidelines for the patient to follow before the surgery. In order to avoid complications, it is ideal that patients strictly follow these guidelines. Total Laparoscopic Hysterectomy with Bilateral Salphingo Oophorectomy is a major surgical procedure which involves several steps and procedures, which are detailed below:

  1.    Before the start of the surgery, the medical professional will administer general or local anaesthetic to the patient, this ensures no pain or discomfort during the surgery. A mask may be strapped to your mouth and nose in order to ensure easy breathing during the surgery
  2.    As this procedure is laparoscopic-assisted, the first step involves the doctor making several small incisions in specific areas of the abdomen. this gives the surgeon easy access to the uterus, ovaries and fallopian tubes. An incision is also made at the vaginal cuff, in order to access the cervix.
  3.    The invention of a device known as a uterine manipulator has made the surgical procedure easier. The flexible nature of the device allows the surgeon to change the angle of the uterus as needed.
  4.    A laparoscope is inserted into one of the incisions, a fibre optic cable with a camera attached to the end. This gives the doctor a full view and navigation of the uterus.
  5.    Long and thin surgical instruments are placed through the other incisions. The ligaments which hold the uterus in place are cut first, then the uterus is cut up into smaller pieces, this is how the uterus is safely extracted.
  6.    Next, the ligaments holding the fallopian tubes and ovaries are cut and they are removed in a similar manner

After the procedure, the patient may wake up in a recovery room recovering from the effects of anaesthesia. As the procedure is Laparoscopic-assisted procedure, the recovery time is considerably faster when compared to other forms of hysterectomy, such as Open abdominal hysterectomy. Laparoscopic hysterectomy is also associated with decreased blood loss and generally lesser complications than abdominal hysterectomy. After the surgery patients may experience pain in the back or shoulder. This is likely due to gas accumulated inside the body which is used during the surgical procedure. Patients should avoid any strenuous or heavy activity for the given time advised by the doctor. It is also advisable to avoid sexual intercourse after the surgery for about 4 to 6 weeks after its completion, in order to give time for the pelvic region to heal sufficiently. Bathing or swimming for some duration after the procedure is also not advised, this is due to the open wounds created during the surgery.

Although total Laparoscopic hysterectomy does have lesser-known complications than other forms of hysterectomy, as with any surgery it is not free of risks.It is a complex procedure, which is why there area number possible complications that could occur. The experience of your doctor and the correct equipment are important for a problem free procedure. Apollo Brookefield ensures the most experienced doctors and state of the line equipment used for every surgical procedure. Detailed below are possible risks of Total Laparoscopic hysterectomy:

  1.    Anaesthesia: Issues with anaesthesia such as rapid breathing
  2.    Internal organ damage: this may occur to the ureter, bladder or bowel. Majority of the time, this can be repaired during the hysterectomy procedure itself
  3.    Bleeding and infection: Can be treated with antibiotics and is not usually serious
  4.    Abdominal incision: If the doctor is unable to remove the uterus through laparoscopic technique, a decision might be made to make an abdominal incision
  5.    Hernia: Developing a hernia at the upper area of the vagina
  6.    Back and shoulder pain: Back pain due to gas accumulation
  7.    Bulge: Bulging in the rectum or vagina, rectocele or cystocele, can be fixed through surgery.
  8.    Sexual intercourse: Pain during sexual intercourse
  9.    Vaginal cuff dehiscence: this is the reopening of the incision created at the original time of hysterectomy, although very rare is a serious and dangerous condition.
  10.    Tumour: In the event of an uncontrolled rupture of a tumour, cancerous cells may spread to other parts of the body.
  11.    Menopause: This is a known side effect of hysterectomy, however, there can be several side effects to menopause which a candidate should be prepared for such as; decreased sex drive, heart disease, depression and anxiety etc.

A few days prior to the surgery, doctors may order a blood test and may want to frequently monitor the patient through tests in order to ensure the best possible conditions during the procedure. Be sure to inform the medical professional honestly about your medical history and any drugs or medication that you might be taking, this can prevent unnecessary or unwanted complications during the surgery and can help the doctor ensure the procedure is best suited to your needs. In order to ensure the best recovery, patients can take certain measures, such as avoiding smoking. Generally, healthier lifestyle and consumption choices will positively affect a patient’s recovery.

Overall, Total Laparoscopic Hysterectomy with Bilateral Salpingo-Oophorectomy is an option for women who have tried other forms of treatment for cases such as abnormal vaginal bleeding or fibroids, and are continuing to experience discomfort and pain. In these cases, the complete removal of the uterus, cervix, fallopian tubes and ovaries is likely to relieve the patient of symptoms. Women who had not already started menopause will after the surgical procedure, as the body cannot produce as much oestrogen after the removal of the ovaries. Otherwise, as a patient who has been diagnosed with cancer in the uterus, ovaries or cervix may opt for total laparoscopic hysterectomy. It may also be considered for patients who wish to eliminate the chances of such a possibility, total laparoscopic hysterectomy is the only solution to completely cure such a condition. After the condition, as much of the female reproductive system is not present after successful surgery women who wish to retain their fertility should not consider a total laparoscopic hysterectomy.  The procedure is one of the most commonly performed major surgical procedures.

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