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Total Laparoscopic Hysterectomy for DUB
General Surgery / Sep 4th, 2016 6:07 am     A+ | a-

This video demonstrates a technique that can be used at total laparoscopic hysterectomy to facilitate removal of a bulky uterus. This 51 year old patient presented with back pain and dyspareunia and medically uncontrolled Dysfunctional uterine bleeding (DUB). During diagnostic imaging, an 3 cm posterior wall fibroid was identified and endometrium thickness was 12mm. She was treated with a total laparoscopic hysterectomy.
Dysfunctional uterine bleeding (DUB) or abnormal uterine bleeding (AUB) is abnormal genital tract bleeding based in the uterus and found in the absence of demonstrable structural or organic disease.
A Total laparoscopic hysterectomy is a minimally invasive surgical procedure to remove the uterus. A small incision is made in the navel through a telescope is inserted. It can be performed by ipsilateral as well as Contralateral port position. The laparoscopic surgeon watches the image from this camera on a TV monitor while performing the procedure. Two to three other tiny incisions are made in the lower abdomen. Through these, specialized instruments are inserted and used for the removal process.
Surgery should be considered only in patients with Dysfunctional uterine bleeding (DUB) in whom medical treatment has failed, cannot be tolerated, or is contraindicated. Endometrial ablation is not acceptable as a primary therapy for Dysfunctional uterine bleeding (DUB), because the procedure can hamper the later use of other common methods for monitoring the endometrium. Regardless of patient age in Dysfunctional uterine bleeding (DUB), progestin therapy with the levonorgestrel intrauterine device should be considered; contraceptives containing a combination of estrogen and progesterone also provide effective treatment.
Low-dose combination hormonal contraceptive therapy (20-35 μg ethinyl estradiol) is the mainstay of treatment for adolescents up to age 18 years. Either low-dose combination hormonal contraceptive treatment or progestin therapy is generally effective in women aged 19-39 years; high-dose estrogen therapy may benefit patients with an extremely heavy menstrual flow or hemodynamic instability. Medical treatment for women aged 40 years or older can, prior to menopause, consist of cyclic progestin therapy, low-dose oral contraceptive pills, the levonorgestrel intrauterine device, or cyclic hormone therapy.
The endometrial ablation procedure is more conservative than hysterectomy and has a shorter recovery time in patient with Dysfunctional uterine bleeding (DUB). Some patients may have persistent bleeding and require repeat procedures or move on to hysterectomy. Rebleeding following ablation has raised concern about the possibility of an occult endometrial cancer developing within a pocket of active endometrium in patient with Dysfunctional uterine bleeding (DUB).
Total Laparoscopic hysterectomy might be necessary in patients with Dysfunctional uterine bleeding (DUB), who have failed or declined hormonal therapy, have symptomatic anemia, and who experience a disruption in their quality of life from persistent, unscheduled bleeding.
If the woman suffering from Dysfunctional uterine bleeding (DUB) and wants to be 100% certain that she will never menstruate again, she needs to have the entire uterus removed by laparoscopy which is called as Total Laparoscopic Hysterectomy. If the patient has a history of pre-cancerous changes of the cervix or the uterine lining, she should have the entire uterus removed. If the operation is being done for endometriosis or pelvic pain, many doctors think the chances for pain reduction are better if the cervix is removed.

In younger patient without any other pathology Supracervical Hysterectomy may be considered.  In a partial or subtotal (supracervical = above the cervix) hysterectomy, the ovaries and/or cervix are left whole. These procedures, too, can be performed laparoscopically. Regrettably, a lot of women either are not made aware or don’t know these options exist. Several doctors take out the cervix automatically as a precaution against cervical cancer. 
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