Minimally invasive surgery
Total Laparoscopic Hysterectomy
Removal of the womb and cervix through keyhole surgery, performed by a specialist in advanced minimally invasive gynaecology.
A total laparoscopic hysterectomy (TLH) is a minimally invasive operation to remove the womb (uterus) and cervix using keyhole surgery.
Instead of making a large incision across the abdomen, the surgeon operates through several small incisions using a camera and specialised surgical instruments.
Depending on your individual circumstances, the fallopian tubes and ovaries may also need to be removed, and lymph nodes may sometimes be assessed or removed as part of cancer surgery.
At Gynae Solution, Mr Jafaru Abu has a particular expertise in advanced minimally invasive gynaecological surgery. He was instrumental in introducing total laparoscopic hysterectomy for the treatment of endometrial cancer at Nottingham University Hospitals and has extensive experience in complex laparoscopic procedures.
What is a total laparoscopic hysterectomy?
A hysterectomy is an operation to remove the womb.
In a total hysterectomy, both the womb and cervix are removed.
A total laparoscopic hysterectomy means that the operation is performed using keyhole surgery rather than through a large abdominal incision.
Small incisions are made in the abdomen, allowing a camera and surgical instruments to be introduced. The surgeon uses the camera to see the pelvic organs on a high-definition screen and performs the operation through these small openings.
Once the womb and cervix have been separated from the surrounding tissues, they are removed through the vagina or, where appropriate, using another suitable technique.
The exact operation will depend on why you are having a hysterectomy, the size and position of your womb and any other medical conditions or previous surgery.
What is removed during a total hysterectomy?
A total hysterectomy removes:
- The womb (uterus)
- The cervix
The fallopian tubes and ovaries do not automatically have to be removed.
Depending on your age, medical history, the reason for surgery and your individual wishes, your surgeon may recommend:
- Keeping both ovaries
- Removing the fallopian tubes while preserving the ovaries
- Removing one ovary and fallopian tube
- Removing both ovaries and fallopian tubes
For some cancers, lymph nodes or additional tissue may also need to be removed as part of the same operation.
Your surgeon will explain exactly what is recommended for you before you consent to surgery.
Why might I need a hysterectomy?
A hysterectomy may be recommended when other treatments have not controlled your symptoms or when surgery provides the most appropriate treatment.
Possible reasons include:
- Fibroids
- Heavy or prolonged menstrual bleeding
- Adenomyosis
- Severe or persistent pelvic pain
- Endometriosis in selected circumstances
- Uterine prolapse
- Certain precancerous conditions
- Endometrial (womb) cancer
- Some cervical cancers
- Selected ovarian or other gynaecological cancers
The decision to have a hysterectomy is individual. For benign conditions, your consultant will normally discuss non-surgical treatments and alternative procedures where appropriate before recommending removal of the womb.
Total laparoscopic hysterectomy for endometrial cancer
A total laparoscopic hysterectomy can be an important part of treatment for selected women with endometrial cancer.
Depending on the stage and characteristics of the cancer, surgery may involve removal of the womb and cervix together with the fallopian tubes and ovaries.
Lymph nodes may also need to be assessed as part of surgical staging. In selected patients, sentinel lymph node assessment or other lymph node surgery may be recommended.
The precise operation depends on the type and stage of cancer and the findings from your scans, biopsy and specialist assessment.
Mr Abu has particular experience in minimally invasive surgery for endometrial cancer and was instrumental in the introduction of total laparoscopic hysterectomy for endometrial cancer at Nottingham University Hospitals.
What is the difference between a total and subtotal hysterectomy?
The terms can sometimes be confusing.
Total hysterectomy
The womb and cervix are removed.
Subtotal hysterectomy
The main body of the womb is removed but the cervix is left in place.
A subtotal hysterectomy is sometimes called a supracervical or partial hysterectomy.
The most appropriate option depends on your individual circumstances and the reason surgery is being recommended.
What is the difference between laparoscopic and open hysterectomy?
There are several ways of performing a hysterectomy.
Laparoscopic hysterectomy
Keyhole surgery using several small abdominal incisions.
Vaginal hysterectomy
The womb is removed through an incision at the top of the vagina, without an abdominal incision.
Abdominal hysterectomy
The womb is removed through a larger incision in the abdomen.
Total laparoscopic hysterectomy
The entire abdominal part of the operation is performed laparoscopically, including division of the uterine blood vessels.
The best approach depends on the reason for surgery, the size and position of the womb, previous surgery, other medical conditions and the complexity of the operation.
What are the potential benefits of keyhole hysterectomy?
When laparoscopic hysterectomy is appropriate, it avoids the larger abdominal incision used for an open hysterectomy.
Potential benefits include:
- Smaller abdominal incisions
- Less abdominal wall trauma
- Less visible scarring
- Reduced wound problems compared with a large abdominal incision
- Earlier mobilisation
- Shorter hospital stay in many patients
- A potentially quicker return to normal activities
- Less need for strong pain medication in some patients
However, these benefits are not guaranteed and recovery varies from person to person.
The most appropriate operation is the one that allows your surgeon to treat the underlying condition safely and effectively.
Is laparoscopic hysterectomy suitable for everyone?
No.
Although laparoscopic hysterectomy is an established and widely used surgical technique, it is not the safest option for every patient.
Your suitability may depend on:
- The size of your womb
- The reason for your hysterectomy
- The presence of large fibroids
- Previous abdominal or pelvic surgery
- Adhesions
- Endometriosis
- Your general health
- Your weight and abdominal anatomy
- The presence or suspicion of cancer
- The complexity of the required surgery
Very large uteri or particularly complex disease may make keyhole surgery more difficult.
In some situations, an open operation may provide safer access and better control.
What happens before a total laparoscopic hysterectomy?
Before surgery, you will have a detailed consultation to discuss your symptoms, diagnosis and treatment options.
Depending on your circumstances, you may have:
- A pelvic examination
- Ultrasound
- MRI or other imaging
- Blood tests
- Cervical assessment where appropriate
- Endometrial biopsy or hysteroscopy
- Assessment of your general health
- Anaesthetic assessment
If your hysterectomy is being performed because of cancer, your case may also be discussed by a specialist multidisciplinary team.
You will be given an opportunity to discuss:
- Why hysterectomy is recommended
- What will be removed
- Whether your ovaries will be preserved
- Whether your fallopian tubes will be removed
- Whether lymph nodes need to be assessed
- Fertility implications
- Menopause and HRT
- Sexual function
- Recovery
- Potential complications
- Alternative treatments
What happens during the operation?
A total laparoscopic hysterectomy is usually performed under a general anaesthetic.
Small incisions are made in the abdomen. Carbon dioxide gas is introduced into the abdomen to create space for the surgeon to operate.
A laparoscope containing a camera is inserted through one incision and specialised instruments through the others.
The surgeon carefully separates the womb and cervix from their surrounding tissues and blood supply.
The uterine vessels are divided laparoscopically and the womb and cervix are removed.
The exact method of removing the uterus depends on its size and the nature of the surgery.
The vaginal closure is then completed and the small abdominal incisions are closed.
If additional procedures are required, such as removal of the fallopian tubes and ovaries or lymph node surgery, these may be performed during the same operation.
Will my ovaries be removed?
Not necessarily.
Removing the ovaries is a separate decision from removing the womb.
If you are premenopausal and your ovaries are healthy, preserving them may allow them to continue producing hormones after hysterectomy.
However, there are circumstances where removing the ovaries and fallopian tubes is recommended, particularly when there is a significant risk of ovarian disease or when surgery is being performed for certain cancers.
If both ovaries are removed before natural menopause, this causes an immediate surgical menopause.
Your consultant will explain the advantages and disadvantages of ovarian preservation in your particular situation.
What happens to my periods after hysterectomy?
After a hysterectomy, you will no longer have menstrual periods because the womb has been removed.
You will also no longer be able to become pregnant.
If your ovaries are preserved, however, they may continue producing hormones and you would not necessarily experience an immediate menopause.
If both ovaries are removed before natural menopause, you will experience a surgical menopause.
This can cause symptoms such as:
- Hot flushes
- Night sweats
- Sleep disturbance
- Vaginal dryness
- Mood changes
- Reduced sexual desire
- Difficulty concentrating
HRT may be appropriate for some women following removal of the ovaries, depending on their individual circumstances. This is particularly important to discuss if you are having surgery at a younger age.
Will hysterectomy affect my fertility?
Yes.
A hysterectomy removes the womb, meaning that pregnancy cannot be carried after the operation.
If preserving your fertility is important to you, it is essential to discuss this before agreeing to hysterectomy.
For some conditions and some early-stage cancers, alternative or fertility-sparing treatments may be possible.
For example, selected women with early cervical cancer may be considered for a fertility-sparing trachelectomy rather than hysterectomy.
The appropriate option depends on your diagnosis and whether preserving fertility can be achieved without compromising cancer treatment.
What are the risks of a total laparoscopic hysterectomy?
A hysterectomy is major surgery and, although most patients recover well, complications can occur.
Potential complications include:
- Bleeding
- Infection
- Blood clots
- Anaesthetic complications
- Injury to the bladder
- Injury to the bowel
- Injury to the ureters
- Damage to blood vessels
- Problems passing urine
- Wound or vaginal cuff problems
- Formation of adhesions
- Need for further surgery
- Conversion to open abdominal surgery
Laparoscopic hysterectomy also carries a recognised risk of urinary tract injury and significant bleeding, which should be discussed as part of informed consent.
Your individual risk depends on the reason for surgery, your medical history and the complexity of the operation.
Could my keyhole operation be changed to open surgery?
Occasionally, yes.
The intention may be to complete the entire operation laparoscopically, but your safety always comes first.
Your surgeon may decide that an open operation is safer if there is:
- Significant bleeding
- Extensive scar tissue or adhesions
- Unexpected anatomy
- A very large uterus
- Extensive disease
- Difficulty safely completing the operation laparoscopically
- Unexpected cancer findings
Changing to an open procedure is not a failure of keyhole surgery. It is a safety decision made to achieve the best possible outcome.
How long will I stay in hospital?
Many patients undergoing laparoscopic hysterectomy are able to go home relatively soon after surgery.
RCOG states that patients may be able to leave hospital within 24 hours, although some need to stay for one to three days depending on their circumstances.
Your hospital stay will depend on:
- The complexity of your surgery
- Your general health
- How well you are recovering
- Whether there were any complications
- Whether you can eat, drink and walk comfortably
- Whether your pain is controlled with tablets
- Whether you are able to pass urine normally
What is recovery like?
It is normal to feel tired following a hysterectomy.
You may experience:
- Abdominal discomfort
- Bloating
- Shoulder-tip pain caused by the gas used during laparoscopy
- Vaginal bleeding or discharge
- Tiredness
- Temporary changes in bowel function
- Temporary urinary symptoms
Light vaginal bleeding or brown discharge can occur during the early recovery period.
You should gradually increase your activity rather than trying to do too much too quickly. Walking regularly is encouraged because it helps circulation, bowel function and recovery.
When can I return to work?
The time needed before returning to work varies considerably.
Someone with a desk-based role may be able to return sooner than someone whose work involves heavy lifting or prolonged physical activity.
Gynae Solution's existing patient information suggests that some patients return to work within approximately 2 to 6 weeks after uncomplicated TLH, although this should be treated as a guide rather than a guarantee.
Your consultant will advise you according to the operation you have had and the type of work you do.
When can I drive?
You should not drive until you are comfortable making an emergency stop and are able to control the vehicle safely without significant pain.
You should also check your insurance company's requirements following surgery.
Your consultant will advise you when driving is appropriate for you.
When can I exercise?
Gentle walking is usually encouraged early in recovery.
You can gradually increase your activity as your strength returns.
More strenuous exercise, heavy lifting and activities that place significant pressure on the abdominal or pelvic area should be avoided until your surgical team confirms that it is safe.
Your recovery plan will depend on the extent of your surgery and how well you are healing.
When can I have sex after a hysterectomy?
You will need to allow time for the internal surgical site at the top of the vagina to heal.
Your surgeon will advise you when it is safe to resume penetrative sex, which is generally after the healing period rather than simply when you feel physically better.
It is completely normal for intimacy to feel different emotionally after a hysterectomy.
If you experience pain, vaginal dryness, reduced desire or concerns about sexual function, speak to your healthcare team. Support is available.
What happens to the tissue removed?
The womb, cervix and any other tissue removed during your operation may be sent to a specialist laboratory for histological examination.
A pathologist examines the tissue under a microscope.
The results can confirm the diagnosis and, if cancer is present, provide important information about its type, stage and other characteristics.
Your consultant will discuss the results with you and explain whether any further treatment or follow-up is required.
When should I seek medical advice after surgery?
You should contact your medical team if you experience:
- Heavy or increasing vaginal bleeding
- Foul-smelling vaginal discharge
- Fever or feeling increasingly unwell
- Increasing abdominal pain
- Redness, swelling or discharge from an abdominal wound
- Difficulty passing urine
- Persistent vomiting
- Increasing swelling or pain in one leg
Seek urgent medical attention if you develop sudden chest pain, significant difficulty breathing or symptoms that could indicate a blood clot.
Why choose specialist laparoscopic surgery?
Total laparoscopic hysterectomy is an advanced surgical procedure that requires specialist laparoscopic skills.
NICE specifically highlights the need for advanced laparoscopic expertise and appropriate training when performing laparoscopic hysterectomy.
Mr Jafaru Abu has a particular interest and extensive experience in minimally invasive gynaecological surgery. He was instrumental in introducing total laparoscopic hysterectomy for endometrial cancer at Nottingham University Hospitals and regularly mentors other consultants in advanced laparoscopic surgery.
At Gynae Solution, the emphasis is not simply on performing surgery through the smallest possible incision. The priority is to select the approach that provides the safest and most effective treatment for your individual circumstances.
A personalised approach to hysterectomy
Having a hysterectomy can be a significant physical and emotional experience.
Whether you are having surgery because of heavy bleeding, fibroids, pelvic pain, endometriosis, prolapse or cancer, you deserve to understand exactly why surgery is being recommended and what it will mean for you afterwards.
At Gynae Solution, Mr Abu and his multidisciplinary team will take the time to explain your diagnosis, discuss the available options and help you make an informed decision about your treatment.
Book a consultation
If you have been advised that you may need a hysterectomy and would like to understand whether a total laparoscopic hysterectomy could be appropriate for you, a specialist consultation can help.
You will have the opportunity to discuss your diagnosis, surgical options, fertility and ovarian preservation, recovery and any concerns you may have before making a decision about treatment.
Patient leaflets
Written for patients, relatives and hospital personnel, to read before your operation and to keep afterwards.
Common questions
How soon can I be seen?
Daily appointments are available at The Park Hospital. Call the secretary on 0115 966 2049, or send an enquiry below and we will reply within 24 hours on business days.
Do I need a GP referral?
Referrals from GPs are welcome, and you can also enquire directly. If you are using private medical insurance, check with your insurer whether a referral is required for your policy. See GP referrals and fees and insurance.
What does a consultation cost?
A new consultation is £250 and a follow-up consultation is £150. The cost of any tests, procedures or surgery is quoted individually after your consultation. See fees and insurance.
Enquiries
Send us a message
Enquiries from patients and referring clinicians are both welcome. We endeavour to answer all enquiries within 24 hours on business days. If your case is urgent, please say so in your message or call the secretary directly.