Total Laparoscopic Hysterectomy and Cholecystectomy together in same patient
Laparascopic hysterectomy is a surgical process aimed at removing the uterus; in which a very small incision is made directly in the navel by inserting a tiny camera. After this, the surgeon in charge looks from the camera on a monitoring TV, the image and monitor the procedure. Very carefully and professionally, some special instruments are inserted and used to remove the process. During hysterectomy, most women are believed to not have their ovaries removed. After the surgery, some of the women can decide to keep the cervix in place or totally remove the whole uterus- a process called "total laparoscopic hysterectomy". Basically, the woman needs no hormones after the surgery as long as the ovaries remain inside.
The idea of keeping the cervix in place makes the operation both faster and safer. While some people think the idea is better for the purpose of sexual enjoyment as time goes on, keeping the cervix in place has approximately a 5% chance of the woman having monthly spotting during her menstrual periods. These ones whose cervices are in place would need to get pap smears on a regular basis, continuously.
In a case where the woman wants to never menstruate again and she wants to be 100% certain, the entire uterus has to be removed. However, if there is a history of pre-cancerous changes of the cervix of the woman, it is advised to have the entire uterus removed. In addition, in a situation whereby the operation is done for pelvic pain, a large number of doctors/surgeons believe the chances of reduction of the pain are more by removing the cervix.
Generally speaking, laparascopic hysterectomy can be subdivided into:
- Laparascopic Assisted Vaginal Hysterectomy; which is the process in which a portion of the operation is done with the laparascope and the other part of the procedure (incision of the vaginal, excision of the cervical tissues) is done transvaginally.
- Total laparoscopic hysterectomy (TLH) which is the process whereby the entire operation is undertaken with the use of the laparascope and the surgical specimen is removed through the vagina.
There are certain steps toward achieving a successful TLH, they include:
- - Preparation and Positioning
- - Uterine Manipulator insertion
- - Abdominal Entry and Trocal Placement
- - Hugging the ovaries
- - Mobilizing the bladder
- - Securing the uterine vessels
- - Separating the uterus and cervix from the vaginal apex
- - Removing the uterus
- - Closing the vaginal cuff
- - and lastly, the post operative management.
Advantages of Laparascopic Hysterectomy Surgery:
1. As against the traditional hysterectomy, in which about 5-6 inch incision has to be done, in laparascopic hysterectomy, just few small incisions are required and in the process, less blood is lost, there is less scarring and after all, less post-operative pain.
2. In addition, laparascopic hysterectomy is done as an outpatient procedure as against the traditional's which requires about 2-3 day hospital stay and the recovery period is 1-2 weeks.
3. There is less risk of blood loss as well as infection with laparascopic hysterectomy that in abdominal hysterectomy.
Summarily, the surgeon that would undertake the laparascopic hysterectomy has to be skilled and up to the task. This is because in the U.S., more than 600,000 hysterectomies are done annually- and record claims they could have be done as laparoscopic or vaginal hysterectomies.
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