Should I remove my uterus by laparoscopy or by laparotomy?

Due to the structural characteristics of the female reproductive system, there are a variety of methods that can be used to remove the diseased uterus. The traditional surgical method is to remove the uterus through the abdomen or vagina. Laparoscopic hysterectomy refers to the process of disconnecting the cruciate ligaments, blood vessels, and vaginal walls around the uterus through laparoscopic surgery, removing the hysterectomy from the vagina, and then suturing the broken ends of the vagina again through laparoscopic surgery. In addition to total hysterectomy, there are several different types of laparoscopic hysterectomy, including laparoscopic-assisted vaginal hysterectomy (LAVH), laparoscopic subtotal hysterectomy, and laparoscopic intramuscular hysterectomy. Is hysterectomy done by laparoscopy or laparotomy?

The surgical method chosen for hysterectomy should be determined based on the patient's actual condition, the hospital's surgical standards, and the surgical habits of the doctor performing the surgery. If the patient's uterus is relatively small and the condition is relatively mild, the general condition is relatively good, the hospital's operating room equipment is relatively complete, and the attending physician is relatively proficient in laparoscopic surgery, laparoscopy can be performed.

Laparoscopy is a minimally invasive surgery that causes less harm to the patient because the incision in the abdominal cavity is relatively small, so recovery after surgery is faster. Since the abdomen is not opened, the impact on the internal organs in the abdomen is relatively small. Therefore, the patient can be hospitalized after 3 to 5 days. However, if the uterus is relatively large, laparoscopic surgery cannot be used for hysterectomy. Since the uterus cannot be removed from the vagina or the abdominal puncture hole after hysterectomy, it may prolong the operation time or cause greater trauma to the patient. In this case, laparotomy is required.

However, if the surgeon performing the surgery is not very skilled and the hospital's equipment is not very complete, it is best to choose laparotomy, because laparotomy is a complete surgery that can be seen very clearly under observation, so the complications of the surgery are relatively rare.

Advantages and characteristics of laparoscopic hysterectomy

Laparoscopic hysterectomy was first performed in 1989. With the development of various operating room instruments, this operation has been vigorously carried out. Compared with open hysterectomy, laparoscopic hysterectomy has significant advantages due to its minimally invasive nature, including shorter hospitalization time, less pain after surgery, faster recovery from life and work, and smaller abdominal incision.

Although LAVH is easy to perform due to the relatively few operations under laparoscopy, the vaginal surgery part of LAVH is very difficult for some difficult cases, such as endometriosis and pelvic adhesions, which make the uterus difficult to pull out. For such patients, laparoscopic hysterectomy is relatively easy because it is completely performed under laparoscopy.

Compared with abdominal hysterectomy and vaginal hysterectomy, the field of vision of laparoscope is clearer. For patients with combined endometriosis and pelvic adhesions, laparoscopic hysterectomy avoids the difficulty of vaginal surgery and the trauma of open surgery, expanding the scope of minimally invasive surgery, and is more advantageous.

In addition to performing laparoscopic hysterectomy, laparoscopic treatments for other diseases can also be performed, such as endometriosis removal, uterine and ovarian tumor removal, vaginal stump suspension training, laparoscopic pelvic defect repair, bladder, neck, pubic cruciate ligament suspension training, etc. In addition, laparoscopic lymph node dissection can also be performed to treat endometrial cancer.

Compared with open hysterectomy, it has a smaller incision, fewer postoperative complications, less need for postoperative pain relief, and can quickly return to work and life. The small incision of laparoscopy is more beneficial to obese patients, as it allows clear vision during the operation and avoids the problem of poor healing caused by large abdominal incisions.