Hysterectomy, the surgical removal of the uterus, is one of the most common gynecological procedures performed worldwide. Traditionally carried out through abdominal or vaginal approaches, the advent of minimally invasive surgery has transformed the way hysterectomies are performed. Laparoscopic hysterectomy has gained popularity because it offers the benefits of small incisions, faster recovery, less postoperative pain, and improved cosmetic outcomes compared to conventional open procedures.

Introduction

A hysterectomy may be recommended for a variety of benign and malignant gynecological conditions. With advancements in surgical techniques and instrumentation, laparoscopy now allows surgeons to perform hysterectomy with high precision and safety while significantly reducing surgical morbidity.

The approach can be purely laparoscopic or assisted, depending on the indication and complexity of the case. The overall goal remains the same: complete removal of the uterus, with or without the cervix and adnexa, while minimizing trauma to surrounding tissues.

Indications for Laparoscopic Hysterectomy

Laparoscopic hysterectomy is indicated in a wide range of gynecological conditions, such as:

Symptomatic fibroids (leiomyomas) causing heavy bleeding or pelvic pain.

Endometriosis with severe symptoms or distortion of pelvic anatomy.

Abnormal uterine bleeding not responding to medical management.

Adenomyosis associated with chronic pain and heavy periods.

Pelvic organ prolapse requiring surgical correction.

Gynecological malignancies, such as early-stage endometrial or cervical cancer (in carefully selected cases).

Types of Laparoscopic Hysterectomy

Several variations exist depending on how the procedure is performed:

Total Laparoscopic Hysterectomy (TLH) – Both the uterus and cervix are removed entirely through laparoscopic dissection.

Laparoscopic-Assisted Vaginal Hysterectomy (LAVH) – Initial dissection is done laparoscopically, but the uterus is removed via the vaginal route.

Laparoscopic Supracervical Hysterectomy (LSH) – The uterine body is removed while leaving the cervix intact.

Radical Laparoscopic Hysterectomy – Performed for certain malignancies, involving removal of the uterus, cervix, parametrial tissue, and upper vagina.

The choice of procedure depends on the indication, the patient’s anatomy, and the surgeon’s expertise.

Patient Preparation

Before surgery, patients undergo a complete evaluation, including blood tests, imaging (such as ultrasound or MRI), and anesthesia clearance. Bowel preparation may be advised in selected cases. Prophylactic antibiotics are administered, and thromboprophylaxis is considered to reduce the risk of blood clots. Patients must be counseled about the risks, benefits, and irreversibility of the procedure.

Surgical Technique

Anesthesia and Positioning
The procedure is performed under general anesthesia. The patient is placed in the lithotomy position with a Trendelenburg tilt, which allows abdominal contents to fall away from the pelvis for better visualization.

Port Placement

A 10 mm camera port is inserted at the umbilicus after pneumoperitoneum is created with CO₂.

Two or three 5 mm working ports are placed in the lower abdomen, typically lateral to the rectus muscles.

Dissection

The surgeon begins by coagulating and cutting the round ligaments.

The bladder is dissected downward to expose the uterovesical space.

The infundibulopelvic ligament (if ovaries are removed) or utero-ovarian ligament (if ovaries are preserved) is coagulated and divided.

The uterine arteries are skeletonized, coagulated, and cut near the cervix.

Removal of the Uterus

In TLH, the uterus is detached completely and removed either vaginally or through morcellation in a retrieval bag.

In LSH, only the uterine corpus is removed, leaving the cervix intact.

Closure

The vaginal cuff (in TLH or LAVH) is closed laparoscopically with sutures.

Hemostasis is ensured, pneumoperitoneum is released, and port sites are closed.

Advantages of Laparoscopic Hysterectomy

Minimally invasive: Small incisions reduce trauma.

Faster recovery: Most patients resume normal activities within 1–2 weeks.

Reduced blood loss compared to open hysterectomy.

Less postoperative pain and reduced analgesic requirement.

Better cosmetic outcome with minimal scarring.

Shorter hospital stay and lower overall morbidity.

Risks and Complications

Although generally safe, laparoscopic hysterectomy is not free from risks. Potential complications include:

Injury to adjacent organs such as bladder, ureter, or bowel.

Hemorrhage from uterine or ovarian vessels.

Infections at the port site or pelvic cavity.

Vaginal cuff dehiscence, though rare.

Anesthesia-related complications.

Careful surgical technique and proper training minimize these risks.

Postoperative Care

Patients are usually mobilized within a few hours after surgery and discharged within 24–48 hours. Oral intake is resumed early. Pain is managed with oral analgesics. Follow-up visits are scheduled to monitor wound healing and ensure recovery. Patients are advised to avoid heavy lifting or strenuous activity for at least 4–6 weeks.

Conclusion

Laparoscopic hysterectomy has become a preferred surgical approach for many gynecological conditions requiring uterine removal. It combines the therapeutic benefits of hysterectomy with the advantages of minimally invasive surgery. With reduced pain, faster recovery, and excellent outcomes, it has set a new standard in gynecological surgery. However, the success of the procedure depends greatly on surgeon expertise, careful patient selection, and adherence to surgical principles. For women requiring hysterectomy, laparoscopy provides a safe and effective pathway to improved quality of life.