Total laparoscopic hysterectomy is a surgical procedure for the removal of the uterus. In this technique, the uterus is separated from the inside of the body and removed in small pieces through small incisions or through the vagina. A hysterectomy is a major surgical procedure and has both psychological and physical consequences. Laparoscopic hysterectomy involves removing the entire uterus with minimally-invasive techniques, using a narrow telescope-like instrument (laparoscope) to see the inside of the abdomen. Under complete general anesthesia, the abdomen is first inflated with carbon dioxide gas to create space for operating. Four or five incisions (1/4 to ½ inch each) are made in the navel and lower abdomen to allow insertion of both the laparoscope and long, narrow instruments through tubes called “ports.” (When using the robot, the incisions are higher up, at the level of the belly button and higher up towards the head.) A normal-sized uterus, once it is detached from its supports, can be removed through the vagina. A large uterus can be reduced to smaller pieces using a laparoscopic morcellator. With our long experience and high volume, we are comfortable removing a uterus as large as a 30-week pregnancy.
Once the uterus is removed, the inside edges of the vagina are brought together using suture, which is readily done laparoscopically. We credit our extensive laparoscopic experience over the years for this achievement.