Laparoscopic hysterectomy.

Abstract

Laparoscopic hysterectomy is a substitute for abdominal hysterectomy and not for vaginal hysterectomy. Most hysterectomies currently performed with an abdominal approach may be performed with laparoscopic dissection of part or all of the abdominal portion followed by vaginal removal, including fibroids of 1000 g. There are many surgical advantages, particularly magnification of anatomy and pathology, easy access to the vagina and rectum, and the ability to achieve complete haemostasis and clot evacuation during underwater examination. Patient advantages are multiple and are related to avoidance of a pain producing abdominal incision. They include a reduced period of hospitalization and recuperation and an extremely low rate of cuff infection and ileus. It must be emphasized that conversion to laparotomy when the surgeon becomes uncomfortable with the laparoscopic approach should never be considered a complication; it is rather a prudent surgical decision that will profoundly decrease patient risk. The laparoscope can be used in combination with hysterectomy in a variety of ways with significant surgical and patient advantages. With few exceptions, laparoscopic hysterectomy can replace abdominal hysterectomy. Surgical outcome is the same. In experienced hands, the complication rate is low. Patient benefits are related to avoidance of an abdominal incision and include improved cosmetics and more rapid recovery.