Hysterectomy, the surgical removal of the uterus, is one of the most frequently performed procedures in gynecology. Traditionally done through an abdominal incision, modern advances in minimally invasive surgery have made laparoscopic hysterectomy a safe and effective alternative.

Laparoscopic hysterectomy offers smaller incisions, reduced postoperative pain, faster recovery, and excellent cosmetic outcomes. It is suitable for a variety of gynecologic conditions, including fibroids, adenomyosis, abnormal uterine bleeding, endometriosis, and early-stage malignancies.

Dr. R. K. Mishra, a pioneer in minimally invasive gynecology, has demonstrated laparoscopic hysterectomy techniques that combine precision, safety, and efficiency, making it a preferred method in contemporary surgical practice.

Indications

Laparoscopic hysterectomy is indicated in patients with:

Benign conditions:

Symptomatic uterine fibroids

Adenomyosis

Abnormal uterine bleeding not responding to medical therapy

Endometriosis causing pain or infertility

Malignancy:

Early-stage endometrial, cervical, or ovarian cancer

Pelvic organ prolapse associated with uterine pathology

Contraindications include severe cardiopulmonary disease, extensive abdominal adhesions, or inability to tolerate general anesthesia.

Preoperative Preparation

Patient Evaluation:

Detailed history and examination to assess uterine size, mobility, and comorbidities

Imaging with ultrasound or MRI for large uteri or complex pathology

Laboratory Workup:

Complete blood count, coagulation profile, and renal function tests

Blood grouping and crossmatching in case transfusion is required

Patient Counseling:

Discuss surgical approach, benefits, risks, recovery time, and potential complications

Explain postoperative care, activity restrictions, and follow-up requirements

Anesthesia:

General anesthesia is preferred to allow optimal abdominal relaxation and patient positioning

Surgical Technique
Patient Positioning and Port Placement

Patient is placed in dorsal lithotomy position with a slight Trendelenburg tilt to allow pelvic organs to fall away from the operative field

Umbilical port (10–12 mm) for the laparoscope

Accessory ports (5 mm) for working instruments, placed to optimize triangulation and ergonomics

Uterine Mobilization

Identify and ligate round ligaments, ovarian ligaments, and uterine arteries

Dissect the broad ligaments while carefully protecting the ureters and bladder

Adhesions, if present, are gently lysed to allow uterine mobilization

Dissection and Detachment

Uterine vessels are sealed and divided using bipolar energy or harmonic devices

Bladder is carefully dissected off the cervix

The uterus is detached from the vaginal vault or cervix depending on the type of hysterectomy

Specimen Removal

The uterus may be removed vaginally or through laparoscopic morcellation for large uteri

Ensure proper handling to prevent spillage or contamination

Vaginal Cuff or Abdominal Closure

The vaginal cuff is sutured with absorbable sutures

Hemostasis is checked, and laparoscopic ports are closed with absorbable sutures or skin adhesive

Advantages of Laparoscopic Hysterectomy

Minimally invasive: Reduced postoperative pain and smaller scars

Faster recovery: Patients resume normal activities sooner than after abdominal hysterectomy

Shorter hospital stay: Many procedures are performed as short-stay surgeries

Enhanced visualization: Magnified view improves anatomic precision and reduces risk of injury to surrounding organs

Lower risk of infection: Smaller incisions reduce wound-related complications

Applicable to large or complex uteri when performed by experienced surgeons

Dr. R. K. Mishra emphasizes that proper patient selection and surgical expertise are critical for optimal outcomes.

Challenges

Steep learning curve: Surgeons must master laparoscopic skills and energy device handling

Limited working space: Large uteri or adhesions can complicate dissection

Vascularity: Increased bleeding risk requires meticulous hemostasis

Morcellation risks: Tissue dissemination should be considered, especially in cases of suspected malignancy

Postoperative Care

Early ambulation and oral intake

Pain management with oral analgesics

Monitor for bleeding, infection, or urinary complications

Resume normal activity gradually, avoiding heavy lifting for 4–6 weeks

Follow-up to check healing and ensure absence of complications

Conclusion

Laparoscopic hysterectomy represents a significant advancement in gynecologic surgery, providing safe, effective, and patient-friendly solutions for a wide range of uterine pathologies.

With meticulous technique, precise dissection, and adherence to safety principles, surgeons can achieve excellent outcomes, minimal complications, and faster recovery.

Training under experts like Dr. R. K. Mishra ensures that gynecologic surgeons gain the skills and confidence needed to perform laparoscopic hysterectomy even in complex cases, making it a preferred approach in modern gynecology.