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Jersey Gynae Clinic

Major keyhole surgery

Total Laparoscopic Hysterectomy (TLH ± BSO)

Keyhole removal of the womb, cervix and (where indicated) the fallopian tubes and ovaries. Faster recovery and smaller scars than open hysterectomy.

  • At hospital
  • 90–180 minutes
  • General anaesthetic
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Overview

About this procedure.

A Total Laparoscopic Hysterectomy (TLH) removes the womb and cervix through small keyhole incisions, with the uterus delivered through the vagina. Where indicated, Bilateral Salpingo-Oophorectomy (BSO) removes both fallopian tubes and ovaries in the same operation.

Because it is keyhole surgery, most patients heal much faster than with traditional open hysterectomy: smaller scars, less pain, shorter hospital stay and a quicker return to normal activity.

What this means for you: you will no longer have periods or be able to get pregnant. If both ovaries are removed before natural menopause, you will be in surgical menopause from the day of the operation; Mr Orabi will discuss HRT with you in advance.

Setting

At hospital

Duration

90–180 minutes

Anaesthetic

General anaesthetic

Indications

What it's for.

  • Heavy bleeding that has not responded to other treatments

  • Large or symptomatic fibroids

  • Severe endometriosis or adenomyosis

  • Endometrial hyperplasia or early-stage cancer

  • Risk-reducing surgery in selected high-risk patients

  • Symptomatic prolapse in selected cases

On the day

How it's done.

  1. Procedure done under general anaesthetic

  2. Three or four small (5–10 mm) incisions on the abdomen

  3. A camera and slender instruments are passed through these incisions

  4. The womb (and cervix, tubes and ovaries when indicated) is detached and removed through the vagina

  5. The top of the vagina is closed laparoscopically

  6. Where indicated, both fallopian tubes and ovaries are removed at the same time (BSO)

Recovery

After your procedure.

  • Most patients stay in hospital for one to two nights

  • Light walking the same day helps recovery

  • Vaginal discharge for two to four weeks is normal

  • Avoid heavy lifting, intercourse and tampons for six weeks

  • Return to work usually between four and six weeks

Benefits

Why this approach.

  • Smaller cuts and less postoperative pain than open surgery

  • Shorter hospital stay

  • Faster return to normal activity, usually within four to six weeks

  • Definitive relief of heavy bleeding

Risks

What to be aware of.

  • Bleeding, occasionally requiring transfusion
  • Infection of bladder, wound or vaginal vault
  • Injury to bladder, bowel, ureter or blood vessels (rare)
  • Vaginal vault dehiscence (rare opening of the vaginal cuff)
  • If both ovaries are removed before natural menopause, instant surgical menopause; HRT is usually discussed in advance

Related conditions

Often seen alongside.