Total Laparoscopic Hysterectomy (TLH)
Total Laparoscopic Hysterectomy (TLH) is an operation to remove the uterus (womb) and cervix with the aid of a small operating telescope, called a laparoscope. The laparoscope is inserted into the abdominal wall through a small incision and allows the doctor to examine the pelvis/abdomen. The uterus and cervix are removed without making a large abdominal incision. Hysterectomy does not require the removal of the ovaries; however the ovaries and tubes can be removed at the time of the hysterectomy if medically necessary.
Procedure: After sedation from general anesthesia is achieved; the doctor will make a small incision at or near your belly button, depending on the size of your uterus, for the laparoscope to be passed through and 2-4 additional incisions in
your lower abdomen to insert necessary surgical instruments. Carbon dioxide gas will be used to inflate the abdomen to
allow the doctor to insert the laparoscope and visualize the abdomen/pelvis. Through the guidance of the laparoscope
the uterus will be freed from ligaments and surrounding blood vessels.
An incision will be made at the top of the vagina to release the uterus and cervix; the vaginal incision will then be closed with dissolvable sutures and necessary blood vessels will be cauterized to prevent bleeding. The uterus is then removed through the vagina. If the uterus is large then an instrument called a Morcellator may be used to divide the uterus into small sections that are then removed from the body through one of the incisions. The procedure is then completed by suturing the top of the vagina, the necessary layers of the abdomen and skin, and then placing dressings over the incision sites.
Diagnosis: The most common reasons to have a TLH are: Fibroids- non cancerous tumors that cause pelvic pain, heavy
and abnormal uterine bleeding, painful intercourse, or other symptoms. Endometriosis- growth of uterine lining in other
parts of the abdomen or uterine muscle (adenomyosis) that causes pelvic pain. Uterine prolapse-the downward
movement of the uterus into the vagina.
TLH is also done for treatment of pre-cancerous lesions and gynecological cancers. Your physician will discuss your diagnosis with you prior to surgery and it will be documented in your medical record.