Comparing Hysterectomy Techniques: Laparoscopic vs Traditional Approaches

Comparing Hysterectomy Techniques: Laparoscopic vs Traditional Approaches

A 2018 WHO study found that the hysterectomy rate was approximately 17 per 1,000 ever-married women in India, indicating its prevalence. Hysterectomy is a process that involves the removal of the uterus from the woman's body. This procedure can also include removing fallopian tubes, ovaries, and cervix if the doctor’s analysis suggests that.

Sometimes, patients can choose which technique to use, but sometimes, it's only the doctor's call. With the new technological advancement in medical science, this operation can be conducted in 2 ways: through laparoscopy or a traditional (open) approach. Let’s explore these approaches in detail.

Laparoscopic Hysterectomy:

Laparoscopic Hysterectomy is a modern-day procedure which is less intrusive and less painful. This surgery requires a

• Laparoscope to make an incision,
• a thin tube with a small camera installed in it.

This tube is inserted inside the small incision in the tummy. Laparoscopic hysterectomy has many benefits-

• Minimum scarring as the incision is small.
• Laparoscopic hysterectomy often involves shorter hospital stays as the procedure involves small cuts compared to traditional open procedures.
• The surgery contributes to a faster recovery as the incision is small and does not end up with many stitches. After this surgery, some women are fit to work after two to three weeks.

Types Of Laparoscopic Hysterectomy Techniques-

Total Laparoscopic Hysterectomy (TLH)

If TLH is operated explicitly to remove cancer- it can involve the removal of the ovaries, pelvic lymph nodes, and the fallopian tubes. Total Laparoscopic hysterectomy is the procedure of removal of the uterus and cervix.

Laparoscopic-Assisted Vaginal Hysterectomy (LAVH)

Similar to TLH, it also involves a small incision on the belly, but unlike TLH, this surgery is conducted through the uterus to remove the uterus. LAVH is considered a hybrid approach as it combines both laparoscopic and vaginal approaches to remove the uterus. This is performed when a doctor's analysis suggests that the vaginal approach alone will not be sufficient enough and requires additional visualisation.

 

Traditional Hysterectomy:

Traditional hysterectomy was the only solution to many conditions which were related to the uterus for centuries. In some cases, it is still considered a relevant option, but due to the advancement and continuous evolution in the procedure, a less invasive procedure is given higher preference. In an open Hysterectomy, a cut on the lower belly is made to remove the uterus. Traditional Hysterectomy is a road which is advised by the doctors only if-

• Women have a large uterus.
• The doctor wants to check the other pelvic organs for any signs of infection.

Here are some of the potential drawbacks of the Open Hysterectomy-

• Increased postoperative pain- The large abdomen cut and greater extent of tissue disruption increases the pain and discomfort when compared with the Laparoscopic surgery.
• The recovery process of open surgery is longer as the stitches take time to dry, which increases the stay in the hospital.
• Since the nature of the operation is open, it leads to certain health risks like- blood loss, high chances of infection, etc.

Comparative Analysis Laparoscopic v/s Traditional

Let's see which one of these two techniques is better suited.

1. An open hysterectomy, as the name suggests, involves a relatively bigger incision on the lower abdomen, which is more invasive, whereas Keyhole surgery is a minimally invasive approach.
2. Patients who go through laparoscopic surgery experience less post-operative pain. In contrast, in traditional hysterectomies, more tissue disruption causes extra pain, and it takes extra time to heal.
3. The risk of infection is higher in Traditional surgery as the process is invasive. In laparoscopic surgery, there is reduced exposure of internal tissue, which helps minimise the chances of infection.
4. In laparoscopic surgery, the scarring is very minimal, whereas in open surgery, the incision size is larger, which leaves evident marks on the belly.
5. In complex cases, laparoscopic surgery is not considered a viable option due to its limited visibility. In contrast, in traditional surgery, that is not a problem, as thorough exploration for any signs of internal infection can be conducted efficiently.

 

Factors That Influence The Route Of Hysterectomy

Many factors influence the route to Hysterectomy. Some of those factors include-

 

• Uterine Disorder

Uterine problems are issues that are related to the uterus. The uterine disorder also contributes to the issue of infertility in some girls. According to a study performed between 2019- 2021, 51% of self-reported instances suggest uterine disorder, which results in hysterectomy. The most common disorders related to the uterus include

• endometriosis
• fibroids
• adenomyosis

• Excessive Bleeding During Periods

A published paper in January 2023 suggests that 33.7% of women in India have to go through a hysterectomy due to excessive bleeding. Usually, periods last for a week, but some women face the issue of excessive bleeding where their bodies don’t respond to oral medications as well then, a hysterectomy is conducted to solve the problem.

• Fibroids

Uterine fibroids are the growths of the uterus. While some fibroids can be so small that they are not visible through the eyes, in some cases, they grow up to the size of a grapefruit or even bigger. In those cases, a hysterectomy is conducted as there is a chance that fibroid can damage the insides of the woman's body.

- Cancer

When cancer spreads in the cervix or area around the area, a hysterectomy is the solution. In such cases, the entire uterus, the area around it, the tissue around the uterus and the upper part of the Vagina are entirely removed.

Conclusion

Choosing between laparoscopic and traditional Hysterectomy involves

• Careful consideration of individual patient's characteristics.
• The nature of the uterine condition.
• The surgeon's expertise.

Traditional Hysterectomy is widely considered an option by doctors in cases that are complex and require a more extensive surgical approach. Still, this procedure leaves an evident scar on the abdomen area and requires relatively more time to heal. The post-operative pain associated with Open hysterectomy is comparatively more than Laparoscopic surgery.

If you are also undergoing a similar operation, consult Dr. Pankhuri Gautam, an obstetrician and a pelvic surgeon. She has been practising for the last ten years, and her immense expertise will help make an informed decision.