A laparoscopic subtotal hysterectomy may be right for you if your family is complete and you no longer require your uterus, or you are sure you do not want to have children and find the pain associated with conditions like adenomyosis is disabling and ruining your life or if there are just too many fibroids to be able to repair the uterus after removing them. The recovery from a subtotal hysterectomy is much faster than recovering from a myomectomy because there is very little damaged tissue to repair or heal. This is especially true if the subtotal hysyterectomy can be done laparoscopically.
Once the uterus with all the fibroids has been separated from the cervix it is removed from the abdominal cavity by cutting it into thin strips using an instrument called a morcellator introduced through a small incision of 1cm in diameter on the lower abdomen.
If there is a malignancy within the fibroids or uterus, it is possible that morcellating the tissue could spread the cancer more widely and morcellation is not recommended where there is any suspicion or a high chance of malignancy. The Royal College of Obstetricians and gynaecologists has produced a leaflet explaining the pros and cons of morcellation. You can view the document here. The risk of a malignancy increases as you get older and morcellation is contraindicated in women after the menopause.
Some people like to have a full idea of the surgical processes involved. For others this is “too much information”. If you are not squeamish and would like to see diagrams surgical images and an operative video of a subtotal hysterectomy please follow this link.
The image below shows the anatomy which may be helpful to explain the process. Using an instrument that coagulates the tissue and then cuts it, the round ligament, utero-ovarian ligament and Fallopian tube are divided with virtually no bleeding at all. Then the tissue of the broad ligament, the tissue alongside the uterus, is divided down as far as the uterine artery which enters the uterus from the side at the level of the cervix. It is important that the ascending branch of this artery is sealed and then the whole of the upper part of the uterus is removed using a diathermy loop which lassoes the uterus at the level of the cervix. Once the uterus is disconnected from the cervix and any small blood vessels cauterised, the uterus is morcellated and the specimen will be sent for histological examination to exclude any malignancy.
