Laparoscopic hysterectomy: your frequently asked questions answered

Written by: Mr Chellappah Gnanachandran
Edited by: Conor Dunworth

Hysterectomy is a procedure in which the uterus is removed, commonly done to treat fibroids or heavy periods. Laparoscopic hysterectomy has several advantages over open surgery, as explained by leading laparoscopic surgeon and consultant gynaecologist Mr Chellappah Gnanachandran in our latest article.

I need a hysterectomy for heavy bleeding due to fibroids and adenomyosis: why should I consider laparoscopic hysterectomy instead of open hysterectomy?

If a woman has relatively small fibroids, and also suffers from adenomyosis which is when the lining of the womb grows into the muscles, they can experience heavy periods and pelvic pain. Sometimes they can suffer from endometriosis as well.

When we perform a laparoscopic surgical procedure, we can get a thorough assessment of the situation. We can then do a complete hysterectomy, which is associated with minimal scarring and minimal post-operative pain.

In contrast, open hysterectomies are associated with much more chronic pain and post-operative recurring pain. They are mainly done if it’s suspected the patient has ovarian cancer, if they have large fibroids (15 centimetres), or possible malignancies such as sarcoma.

We generally recommend avoiding open hysterectomy if it is at all possible and opting for a keyhole hysterectomy instead.


What are the benefits of laparoscopic hysterectomy compared to open surgery in general?

Almost all hysterectomies are done by laparoscopic surgery. This is because patients recover much faster from laparoscopic surgery. They can usually go home the same day as the surgery and are usually working without any pain after two or three days. There are also fewer complications in high BMI patients such as blood clots in the legs.


Should the cervix be removed during the hysterectomy?

If the patient has chronic pelvic pain after sex, this is usually pain coming from the cervix. In this situation, it is better to have the cervix removed.

A long-term benefit of having the cervix removed is that if the woman needs hormone replacement therapy in the future, they will only need one hormone. If the cervix is not removed, then the patient will need two hormones: oestrogen and progesterone.

However, there are a couple of problems. There is a widespread belief that removing the cervix can negatively impact sexual pleasure, but this has not been proven.

Another widespread belief is that removing the cervix can increase the chances of prolapse. However, most scientific studies have discredited this belief.


Should the ovaries be removed during a hysterectomy?

In women younger than 45, unless they have severe endometriosis it is better to leave the ovaries. This means they won't need hormone replacement therapy and their life satisfaction is generally better. But in patients who have significant endometriosis, or are above 50 years of age, it is better to remove the ovaries.

If the patient has a higher risk of developing ovarian cancer, such as a family history of the disease, the ovaries are usually removed. The patient then typically undergoes hormone replacement therapy, which lessens the risk of developing breast cancer.


What is the recovery period like after a laparoscopic hysterectomy?

After a laparoscopic hysterectomy, some patients might stay overnight, but most go home the same day. We make sure they pass urine twice before they go home. During the first night after the surgery, they can expect a little pain and bleeding. They usually take painkillers and must drink a lot of water.

If they go home on the same day as the surgery, we call them the following morning to make sure they have passed urine and aren’t experiencing significant pain. We also remind them to take any medication they have been prescribed.  

Patients are usually able to do day-to-day work in their home, such as cooking and cleaning around 3 to 5 days after the surgery.

Patients must let us know if they are experiencing bleeding, significant pain, fever or vomiting in the weeks following the surgery. However, most patients have fully recovered and can return to their daily lives within four weeks. 


Mr Chellappah Gnanachandran is a leading laparoscopic surgeon and consultant gynaecologist based in Northampton. If you would like to book a consultation with Mr Gnanachandran, you can do so via his Top Doctors profile today.

By Mr Chellappah Gnanachandran
Obstetrics & gynaecology

Mr Chellappah Gnanachandran (Mr Gnana) is a leading laparoscopic surgeon and a consultant gynaecologist based in Northampton, UK.

He scans all his gynaecology patients himself.  He is one of the few gynaecologists who has a trained degree in scanning.

He currently sees private patients at BMI Three Shires Hospital and Northampton General Hospital. He provides a range of treatments for patients with gynaecology conditions including fibroids, ovarian cysts, and endometriosis.

Mr Gnanachandran specialises particularly in gynaecology scanning and has advanced knowledge in ovarian cyst pathology and endometrial assessment. He also treats young women for early indications of cancer and conditions affecting fertility. Part of his responsibility as a consultant gynaecologist is to help patients avoid unnecessary interventions and allow them to access appropriate early surgery if necessary.

He often carries out ultrasound scans and laparoscopic surgery for patients with subfertility, endometriosis, fibroids and early gynaecology malignancies.

Mr Gnanachandran has given training and lectures nationally on scanning for endometrium, fibroid and IOTA scanning for ovarian cysts.

Mr Gnanachandran graduated from the University of Colombo in Sri Lanka in 2002 before joining the NHS training programme in 2004. In 2005, he began his training in obstetrics and gynaecology and started working in several hospitals throughout Wales and the West Midlands.

Mr Gnanachandran gained a master of science in gynaecology ultrasound at the University of Derby.

In 2016 he was appointed as a consultant at Northampton General Hospital to develop fertility services

He is the current lead for gynaecology rapid access care service which provides tall patients with suspected gynaecological cancers are seen within 2weeks time from referrals.

He completed training in several different aspects of gynaecology including 

1) Ultrasound scan for the pelvic and transvaginal scan.

2) Laparoscopic and hysteroscopic surgeries for benign gynaecological conditions such as fibroids, adenomyosis, and endometriosis

3) Surgery for patients with infertility including hysteroscopic resection of fibroid, polyps and uterine septum

4) Colposcopy and treatment of cervical precancers

5) Gynaecology oncology referrals and early gynaecology cancers such as endometrial cancer early stage.  All cancer patients will need to go through MDT.

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