Information about uterine fibroids
Minimally Invasive Therapy Unit & Endoscopy Training Centre
University Department of Obstetrics and Gynaecology
Royal Free Hospital
Pond Street
Hampstead
London NW3 2QG, UK

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LATEST NEWS

A new website for gynaecologists interested in the surgical management of fibroids is now on line. www.fibroidsurgery.org

Laparoscopic hysterectomy

Laparoscopic hysterectomy is a recent operation which was first described in 1989. It is the equivalent of laparoscopic myomectomy in terms of approach and the instruments used; typically, surgery starts using the laparoscope and miniature instruments inserted through the abdomen, and the hysterectomy is completed through the vagina. If appropriate, ovaries are easily removed at the same time.

Laparoscopic hysterectomy is a slow procedure, just like laparoscopic myomectomy. Recovery, however, is relatively fast, and comparable to vaginal hysterectomy. The complication rate is also generally considered to be similar.

Small abdominal incisions only
Suitable if there are pelvic adhesions or ovarian problems (e.g. ovarian cyst)
Subtotal hysterectomy possible
Relatively fast recovery (similar to vaginal hysterectomy)
Not suitable if fibroids are very large
Longest operating time of all hysterectomies
Ureteric injury more common than with other types of hysterectomy

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Operative laparoscopy

With the aid of small instruments, laparoscopy can also be used to perform surgery formally done by laparotomy (large incision). Laparoscopic procedures are usually associated with shorter hospital, less discomfort and faster recovery.

Indications for laparoscopic surgery include conditions such as endometriosis, adhesions, ovarian cysts, tubal disease. Laparoscopy can also be used to excise fibroids; as with hysteroscopic myomectomy, this route of surgery is only indicated providing the fibroids are not over large or too numerous, and situated mainly on the outside of the uterus.