• Uterine fibromyomas 
• Endometriosis
• Adenomyosis
• Abnormal vaginal bleeding from the uterus (e.g., bleeding during menstruation or during periods with no menstruation) and non-response to medication
• Endometrial hyperplasia, especially when accompanied by atypia (endometrial intraepithelial neoplasia)
• Certain ovarian tumours (e.g., borderline tumours, granular cell tumours)
• Severe dysplasia (e.g., CIN3) and adenocarcinoma in situ (AIS) in the cervix of the uterus
• For prevention reasons in cases of hereditary endometrial cancer syndromes (Lynch syndrome)
• Surgical treatment of endometrial cancer under certain conditions
• Surgical treatment of uterine prolapse under conditions
• Chronic pelvic pain which does not respond to medication

How can I prepare myself before laparoscopic hysterectomy?

Before the scheduled laparoscopic hysterectomy, you should: 

• Discuss with your doctor in detail your medical history and the medication you receive on a daily basis. Sometimes you will need to take more medical examinations (e.g. in case of a heart disease) or have your medication changed (e.g. anticoagulant drugs)
• Stop smoking, since it can increase the risks of anaesthesia or affect your recovery.
• Ask your doctor about what you can eat the day before and after surgery.
• Ask your doctor about how you can prepare your skin so as to minimise the risk of postoperative infection in the incision area
• Discuss with your doctor about the strategies of reducing postoperative consequent pain in detail. It is important to ask about the preoperative and intraoperative choices available in this context.

What happens in the operating room before laparoscopic hysterectomy?

The steps before initiating laparoscopic hysterectomy include:

• The administration of general anaesthesia. Minimally invasive surgeries (robotic surgery and traditional laparoscopy) cannot be performed with other forms of anaesthesia (for example epidural anaesthesia) because of the air used for abdominal distension
• Putting on elastic stockings and intermittent pneumatic compression (IPC) devices to prevent blood clots
• Placement of the patient in gynaecologic position
• Placement of a catheter in the urinary bladder. It is removed a few hours after surgery or in the next morning.
• Placement of a thin tube from the mouth to the stomach for gastric suction. It is removed when the surgery is completed.
• Thorough cleaning of the skin in the surgery area with special antiseptic solutions
• Using sterilized fenestrated sheets on the surgery area.
• Placement of a tool inside the uterus (uterine manipulator). In this way, the uterus can be moved by the gynaecologic surgeon’s assistant during the surgery, and the safe performance of the surgery becomes easier.

How is laparoscopic hysterectomy performed?

In laparoscopic surgery, the gynaecologic surgeon first creates a small incision on the skin under the navel, through which he gains visibility to the inner abdomen (peritoneal cavity). This is followed by abdominal distension with air so as to create distance among the organs, improve doctor’s visibility and make his surgical movements easier while avoiding injury. After the abdomen is distended, the gynaecologic surgeon inserts a camera through the initial incision, which projects the image of the abdomen on a special screen. Then, depending on the type of surgery, usually 3 or 4 more small incisions (0.5-1cm) in the abdomen are necessary in order to insert the special surgical tools for each surgery.

What happens after laparoscopic hysterectomy?

When the uterus is disconnected from the tissue surrounding it, it is removed from the body through the vagina, just like in natural childbirth! The gynaecologic surgeon then sews the vagina, checks the abdomen thoroughly for small sources of bleeding, removes the surgical tools and the air he inserted and closes the small skin incisions with special stitches. Afterwards, the patient is transferred to the recovery room, where she will be monitored for some time. She might sometimes complain about sleepiness or nausea, symptoms associated with the effect of anaesthesia. Postoperative recovery after laparoscopic hysterectomy is very short and the patient is able to walk and eat progressively a few hours later. Depending on the type of surgery and her general history, the patient can return home within 24 hours after surgery in most cases.

What should a woman expect during the first days of recovery after laparoscopic hysterectomy?

The patient might mention a “pulling” sensation or mild pain in the incision areas a few days after laparoscopic hysterectomy. Moreover, she might complain about shoulder or back pain, which is caused by the small amount of air remaining in the abdomen, or blood spotting. The above symptoms usually resolve fully within a few days. The patient should avoid lifting objects heavier than 3kg for 2-3 weeks and avoid sexual activity for 6 weeks. Although recovery is very fast, immediate contact with the doctor is required in the rare cases of experiencing:

• Fever
• Vaginal bleeding
• Severe abdominal pain, nausea or emesis
• Foul-smelling discharge or pollakiuria/burning sensation when urinating
• Redness/fluid in the incision areas

Redness and swelling in your calves, chest pain or shortness of breath