Hysterectomy can be achieved laparoscopically in the vast majority of cases, regardless of the size of the uterus, the pathology involved or prior surgeries. This involves three to four small incisions, the size of the fingertip. Most patients go home the next morning or occasionally on the same day of the surgery.
During your appointment, your physician will be able to answer your questions and make appropriate recommendations regarding keeping or removing the cervix, ovaries and tubes.
- AAGL position statement: Route of hysterectomy to treat benign uterine disease
- Pelvic laparoscopy
- Hysterectomy – laparoscopic – discharge
Our team at UF is capable of removing the ovaries in most cases through a single small incision at the umbilicus, where the scar is almost always invisible and provides excellent cosmetic results (Single Incision Laparoscopic Surgery – SILS).
This procedure is performed for ovarian cysts, masses, or in some patients with breast cancer, patients with BRCA mutations, or sometimes as part of the treatment of pelvic pain caused by severe endometriosis or chronic pelvic inflammatory disease.
Laparoscopic Treatment of Prolapse
Laparoscopic Sacro-Colpopexy is a minimally-invasive procedure that utilizes a permanent mesh to suspend the vagina and pelvic floor to the sacrum. This can be performed in conjunction with laparoscopic hysterectomy as indicated.
Laparoscopic Uterosacral Vaginal Vault Suspension reattaches the vagina to the strong ligaments arising from the sacrum and normally attached to the vagina.
Laparoscopic Ovarian Cystectomy
This procedure involves the laparoscopic removal of ovarian cysts, while preserving the remainder of the ovary. This is indicated for the treatment of ovarian cysts, endometriomas, and dermoid cysts in patients desiring to preserve their fertility or younger patients distant from menopause.
Laparoscopic Excision of Endometriosis
This procedure has two primary indications: 1) the treatment of chronic pelvic pain caused by deep infiltrating endometriosis that has not responded adequately to medical therapy and 2) infertility caused by endometriosis.
Our team provides a multi-specialty approach to the treatment of severe endometriosis involving the bowel, bladder, or ureters.
This is the minimally-invasive removal of fibroids for patients desiring to retain their uterus for childbearing.
Fibroids involving the cavity of the uterus can usually be removed hysteroscopically without incisions.
Most of the above-mentioned procedures can be performed with the assistance of robotic technology. Gynecologic surgeons at the University of Florida are proud to utilize the most advanced robotic technology in the world. Two da Vinci Si robotic systems are housed at Shands at UF and are used routinely for a myriad of gynecologic procedures such as hysterectomy, myomectomy, sacrocolpopexy and adnexal surgery. The da Vinci system provides superior 3-D quality visualization and magnification, along with the precision afforded with its unique wristed instruments. Robotic and minimally-invasive approaches offer significant benefits over traditional open surgery, such as less surgical blood loss, less scarring, less pain, better cosmetic results and faster recovery and return to regular activities. Most patients are able to leave the hospital within 24 hours.
Vaginal hysterectomy is removal of the cervix and uterus through the vagina and does not require any abdominal incisions. In most cases, women spend one night in the hospital after their surgery and are discharged home the following day. The size of the uterus, the number of deliveries a woman has had, prior surgery and other factors determine whether one is a candidate for a vaginal hysterectomy. When indicated, the ovaries can be removed safely during a vaginal hysterectomy.
Disorders of pelvic support (cystocele, rectocele, enterocele, and uterine prolapse) may be treated by the vaginal, laparoscopic, or abdominal approach. When the vaginal approach is appropriate, we primarily do traditonal repairs and reserve mesh-augmented repairs for patients with recurrent prolapse or for patients who are at high risk for recurrence of their prolapse.
Laparoscopic Presacral Neurectomy
Pain sensation from the pelvic organs are carried to the spinal cord through an intricate network of nerve plexuses. Presacral neurectomy entails the surgical interruption of the nerve plexus (Superior hypogastric nerve plexus) carrying pain sensation from the central pelvic organs to the spinal cord. We are one of a few centers in the US that offer this procedure through laparoscopy with tiny incisions. The procedure achieves a high success rate for refractory dysmenorrhea (painful menses) and for endometriosis-associated pelvic pain.
Treatment of Ectopic Pregnancy
Laparoscopic management is currently the standard of care for the surgical management of ectopic pregnancy, in which medical therapy has failed or is contraindicated. Tubal preservation -when feasible- is our standard approach. In other cases, the damaged tube affected by ectopic pregnancy is removed laparoscopically as an outpatient procedure.
Treatment of Mullerian Anomalies
We offer minimally-invasive approaches for treatment of Mullerian anomalies. We employ laparoscopic, hysteroscopic and vaginal approaches as needed when surgical management is indicated.
Hysteroscopic Endometrial Ablation
One of the minimally invasive options for management of abnormal uterine bleeding is through ablation (destruction) or excision of the endometrial lining of the uterine cavity. This offers an alternative to hysterectomy in certain cases. We employ several approaches to endometrial ablation, using the most advanced technology in this field.