Laparoscopic Hysterectomy

Laparoscopic hysterectomy is a surgical procedure in which the uterus is removed using a camera (laparoscope) and fine surgical instruments introduced through several small incisions made in the abdominal wall — in other words, it is a “minimally invasive” uterine removal surgery. In this method, the abdomen is not opened with a large incision; 0.5–1 cm entries are made around the umbilicus and lower abdomen, the abdominal cavity is entered with a camera, and the uterus is removed safely under a magnified image on the screen. The aim is to cause less trauma to the patient, ensure faster recovery and improve the cosmetic result.

Why Is Laparoscopic Hysterectomy Preferred?

There is no single route for every patient who needs the uterus to be removed; among vaginal, laparoscopic, robotic or open abdominal hysterectomy options, the choice is made according to the patient’s condition.
In surgeries performed with the minimally invasive technique, the hospital stay is shorter, wound-site infection is less common and the time to return to work is noticeably shorter.

The main reasons for preferring the laparoscopic route are:

• No large abdominal incision
• Less postoperative pain
• Better control of blood loss
• Faster return to daily life and work
• Better cosmetic outcome
• Possibility of removing the tubes or ovaries in the same session

These advantages make the laparoscopic method attractive especially for women who are actively working, have small children or wish to keep the surgical scar to a minimum.
In addition, since the surgeon works with a magnified image, the pelvic organs can be seen in much more detail; this also makes it easier to treat accompanying endometriosis foci or adhesions in the same session.

In Which Situations Is Laparoscopic Hysterectomy Performed?

Laparoscopic hysterectomy can be performed in many benign gynecological conditions that require removal of the uterus:

• Uterine fibroids (myomas): If the size and location are suitable, the uterus can be removed laparoscopically.
• Uterine bleedings resistant to treatment: In bleedings that cannot be controlled with medication or minor interventions, hysterectomy may be necessary.
• Conditions causing adenomyosis and chronic pelvic pain
• Pre-cancerous endometrial lesions (if the doctor deems it appropriate)
• Cases with uterine prolapse but unsuitable for the vaginal route
• Cases with endometriosis: Laparoscopy allows both removal of the uterus and treatment of lesions in the same session.

Many gynecology clinics in Türkiye define this surgery as “closed uterine removal” and emphasize that it is a comfortable option, especially for women who have completed childbearing and have long-term bleeding or fibroid complaints.

How Is the Surgery Performed?

• The surgery is performed under general anesthesia.
• Three to four small incisions are made around the umbilicus and lower abdomen.
• Carbon dioxide gas is given into the abdominal cavity to create a working space.
• Through the umbilical port, a camera provides a magnified view of the uterus, tubes, ovaries, and bladder.
• With fine instruments inserted through the other ports, the ligaments and vessels are coagulated or tied and divided.
• The uterus is usually removed through the vagina; if not possible, it is removed in pieces through the abdominal ports.
• Finally, the small incisions are closed with 1–2 sutures.

For experienced surgeons, the operation usually takes 1–1.5 hours.
Patients are mobilized a few hours after surgery and most are discharged the following day.

Types of Laparoscopic Hysterectomy

The same technique is not suitable for every patient. Depending on uterine size, cervical condition, the need for repair, and patient preference, the surgeon may choose:

• Total laparoscopic hysterectomy (TLH): The uterus and cervix are removed completely by laparoscopy.
• Laparoscopic-assisted vaginal hysterectomy (LAVH): The upper part of the uterus is freed laparoscopically and the surgery is completed vaginally.
• Supracervical (subtotal) laparoscopic hysterectomy: The uterine body is removed and the cervix left in place to help preserve pelvic support or sexual function.

The appropriate technique is decided after examination, ultrasound, and medical history review.

Advantages

1. Less pain: Small incisions reduce postoperative pain and analgesic need.
2. Less blood loss: Vessels are clearly visible, allowing better bleeding control.
3. Short hospital stay: Most patients are discharged within 1–2 days.
4. Faster return to normal life: Many patients return to work in 2–3 weeks.
5. Better cosmetic result: The small incisions become almost invisible.
6. Treatment of other issues in the same session: Endometriosis, cysts, or tubes can be managed simultaneously.

Possible Risks and Complications

Like any surgery, laparoscopic hysterectomy carries certain risks. The most common are bleeding, infection, injury to nearby organs (bladder, ureter, intestines) and, rarely, conversion to open surgery.
In patients with multiple previous cesarean sections, endometriosis, or extensive adhesions, the surgeon may convert to open surgery for safety.

A mild bloody discharge for several weeks is normal.
However, if:

• Bleeding increases,
• The discharge has a bad odor,
• Fever above 38°C develops,
• Swelling or pain occurs in the legs,
  contact your doctor immediately.

Recovery Process and Aftercare

Most patients start walking on the day of surgery. Gentle walking in the first 24 hours helps release gas and prevent clots.
During the first 10–14 days:

• Avoid heavy lifting,
• Avoid bathtubs and swimming,
• Prevent constipation,
• Avoid sexual intercourse.

Sutures usually dissolve on their own. Patients with desk jobs can return in 2–3 weeks; physically demanding jobs may require 4–6 weeks.
Full recovery of tissue healing generally takes about 6 weeks.

Preoperative Preparation

• A detailed gynecologic examination and ultrasound are performed.
• If needed, endometrial biopsy or hysteroscopy may be done.
• Blood tests and anesthesia assessment are completed.
• Smoking should be stopped; diabetes and hypertension should be well controlled.
• Arrange a helper for the first postoperative days.

A light bowel preparation and antibiotics may be used on the morning of surgery to reduce infection risk.

Who Is Not Suitable?

• Patients with a very large uterus
• Those with widespread intra-abdominal adhesions
• Patients with advanced gynecologic cancer
• Patients with severe cardiac or pulmonary disease

For these cases, vaginal or open abdominal hysterectomy may be safer. The goal is always to choose the safest route.

Difference Between Laparoscopic and Robotic Hysterectomy

Both methods remove the uterus through small abdominal incisions.
Robotic systems provide 3D vision and finer movement control, but they are not necessary in all cases.
Robotic surgery is generally more costly; for most benign uterine diseases, laparoscopic hysterectomy is sufficient, safe, and comfortable.

Conclusion

Laparoscopic hysterectomy is a modern surgical technique that allows safe removal of the uterus in appropriate patients and offers faster recovery compared to open surgery.
With careful preparation, experienced surgeons, and adherence to postoperative care, patients can return to daily life within weeks.
This method is ideal for women seeking a quick recovery, minimal pain, and good cosmetic results.

In Ankara, physicians experienced in laparoscopic hysterectomy, Prof. Dr. Şadıman Kıykaç Altınbaş and Prof. Dr. Ömer Lütfi Tapısız, provide scientific, reliable, and personalized care to their patients. For more information and appointments, please visit our contact page.

Frequently Asked Questions

1. Will I have my period after laparoscopic hysterectomy?
   No. Since the uterus is removed, menstruation will no longer occur. Even if the ovaries are preserved, there will be no menstrual bleeding.
2. When will I be fully recovered?
   Light activities can usually be resumed in 2–3 weeks, and full recovery occurs within 6 weeks.
3. Can laparoscopic surgery turn into open surgery?
   If required for safety, the surgeon may convert to open surgery. This may be necessary due to adhesions or unexpected bleeding.
4. When can I resume sexual activity?
   Generally, 6 weeks should pass for complete healing. Your surgeon will confirm the timing at your follow-up visit.