Laparoscopic Hysterectomy (Removal of the Uterus)

Dr. Wei-Wei Wee-Stekly

Senior Consultant Obstetrician & Gynaecologist

MBBS (London), MRCOG (United Kingdom), MMed (O&G) (Singapore), FAMS (Singapore), FRCOG (United Kingdom)

A hysterectomy — the surgical removal of the uterus — is a major decision for any woman. Thanks to advancements in minimally invasive surgery, many women now have the option of undergoing a laparoscopic hysterectomy, which offers a shorter recovery, smaller incisions, and less postoperative discomfort compared to traditional open surgery.

In eligible patients, this technique allows for safe and effective removal of the uterus through small incisions, without the need for a large abdominal cut.

What Is a Laparoscopic Hysterectomy?

A laparoscopic hysterectomy is a minimally invasive surgery in which the uterus is removed using small incisions in the abdomen. A thin instrument with a camera (laparoscope) and surgical tools are inserted through these incisions to allow the surgeon to operate with precision while viewing the pelvic organs on a monitor.

Depending on the reason for the surgery, the procedure may also involve removal of the cervix, fallopian tubes, or ovaries. The uterus is either removed through the vagina (vaginal hysterectomy with laparoscopic assistance) or broken into smaller pieces and taken out through the abdominal incisions.

Where possible, this method is often preferred over traditional abdominal hysterectomy, which requires a larger incision and longer recovery time.

When Is Hysterectomy Recommended?

A hysterectomy is usually recommended when other treatments have failed or are no longer suitable. Common conditions that may lead to this procedure include:

• Uterine fibroids that cause pain or heavy bleeding
• Endometriosis that is not responding to treatment
• Adenomyosis
• Chronic pelvic pain
• Abnormal uterine bleeding
• Uterine or cervical cancer (in early stages)
• Pelvic organ prolapse
• Precancerous changes in the uterus or cervix

For many women, hysterectomy offers permanent relief from distressing symptoms and improves overall quality of life.

What Are the Types of Laparoscopic Hysterectomy?

There are several approaches to laparoscopic hysterectomy. Your gynaecologist will recommend the most appropriate one based on your medical history and the reason for surgery.

Total Laparoscopic Hysterectomy (TLH)

The uterus and cervix are removed entirely using laparoscopic instruments. This is the most common form and may also include removal of the fallopian tubes and/or ovaries if necessary.

Laparoscopic-Assisted Vaginal Hysterectomy (LAVH)

Laparoscopy is used to guide and assist with the removal of the uterus through the vagina. This is useful when vaginal access is feasible but additional visualisation of the pelvic organs is needed.

Laparoscopic Supracervical Hysterectomy (LSH)

Only the uterus is removed, leaving the cervix in place. This option may be suitable for selected women who wish to retain the cervix and do not have cervical disease.

What Are the Benefits of Laparoscopic Hysterectomy?

Compared to open abdominal surgery, a laparoscopic approach offers several advantages:

• Smaller incisions and minimal scarring
• Less postoperative pain
• Shorter hospital stay (often 1 day or same-day discharge)
• Quicker return to normal activities
• Lower risk of wound infections
• Reduced internal adhesions

These benefits make laparoscopic hysterectomy an attractive option for women seeking effective treatment with a faster, smoother recovery.

Who Is a Suitable Candidate for Laparoscopic Hysterectomy?

Most women requiring hysterectomy for benign conditions are good candidates for laparoscopic surgery. It is especially beneficial for:

• Women who want to minimise downtime
• Those who prefer a minimally invasive approach
• Women with early-stage gynaecological cancer (after evaluation)
• Women who are not obese or who have a manageable surgical history

In some cases — such as with very large uterine fibroids, extensive pelvic adhesions, or advanced cancer — an open abdominal approach may still be needed. Your doctor will assess your medical history, imaging results, and treatment goals to determine suitability.

What Happens Before Laparoscopic Hysterectomy?

Before your surgery, you’ll attend a preoperative consultation where your doctor will:

• Review your medical history
• Conduct a physical and pelvic examination
• Order imaging (ultrasound or MRI) and blood tests
• Discuss whether the ovaries or cervix will be removed
• Provide instructions on fasting, medications, and hospital admission

You’ll also receive guidance on what to expect post-surgery and have the opportunity to ask questions or raise any concerns.

What Happens During Laparoscopic Hysterectomy?

Laparoscopic hysterectomy is performed under general anaesthesia and typically takes between one and three hours.

• Small incisions are made near the navel and lower abdomen
• A laparoscope and surgical instruments are inserted
• The uterus is detached from surrounding structures, including the ligaments and blood vessels
• The uterus is removed either vaginally or through one of the incisions
• Incisions are closed with dissolvable stitches or skin glue

Most women are able to return home the same day or the following morning.

What Can You Expect After Laparoscopic Hysterectomy?

Recovery from a laparoscopic hysterectomy is generally smooth and well tolerated. Common experiences in the first few days include:

• Mild to moderate cramping or bloating
• Vaginal spotting for up to 2 weeks
• Fatigue, especially in the first week
• Shoulder or upper back pain due to gas used during surgery (usually resolves quickly)

Most women can:

• Walk around on the same day as surgery
• Resume light activity within a few days
• Return to work in 1–2 weeks (depending on the nature of your job)
• Resume sexual activity after 6 weeks or as advised

Your doctor will schedule a follow-up to monitor healing and discuss hormone management if your ovaries were removed.

Will a Hysterectomy Affect My Hormones?

If your ovaries are not removed, your body will continue producing hormones as usual, and you won’t experience menopause as a result of the surgery.

If your ovaries are removed (called bilateral oophorectomy), you will experience surgical menopause — a sudden drop in hormone levels. This can lead to hot flushes, mood changes, and other symptoms, which can often be managed with hormone replacement therapy (HRT) if appropriate.

Your doctor will discuss this in detail and help you prepare for any changes based on your surgical plan.

When Should You Consider a Laparoscopic Hysterectomy?

You may want to explore this option if you:

• Have fibroids, endometriosis , or adenomyosis that no longer respond to medication
• Experience heavy bleeding or pelvic pain affecting daily life
• Are seeking permanent relief from uterine-related symptoms
• Have completed your family or no longer wish to become pregnant
• Prefer a minimally invasive procedure with quicker recovery

An early conversation with your gynaecologist allows you to fully understand your options and make an informed choice based on your health and lifestyle.