A laparoscopic hysterectomy (LH) is a procedure to remove the uterus through several small openings in the abdomen, rather than a single large incision. This minimally invasive technique uses long, thin instruments and a specialized camera. The number of incisions required is a primary concern for patients, as it affects recovery and appearance. The number of cuts can range from one to six, depending on the specific surgical approach utilized.
The Standard Number and Placement of Incisions
The conventional laparoscopic hysterectomy typically involves three to five small incisions, known as ports, on the abdominal wall. These openings usually measure between 5 and 12 millimeters in diameter. Strategic placement ensures the surgeon has optimal access and viewing angles.
One primary incision is placed at or near the navel for inserting the laparoscope, a specialized camera that provides a magnified view. The remaining two to four incisions are positioned in the lower abdomen for the entry of working instruments. This multi-port approach provides the necessary triangulation for precise cutting, grasping, and suturing within the abdominal cavity.
Specialized Approaches That Change the Incision Count
Specialized techniques can significantly alter the number of necessary incisions compared to the standard multi-port procedure.
Single-Port Laparoscopy
The single-site or single-port laparoscopy (SPS) is a variation conducted through a single cut, usually placed within the navel. This opening is slightly larger than a standard port, sometimes measuring up to 2.5 centimeters. The advantage is that the resulting scar is virtually hidden in the natural crease of the belly button.
Robotic-Assisted Laparoscopy
Robotic-assisted laparoscopic hysterectomy often requires a higher number of incisions than the traditional method. The robotic system, such as the da Vinci Surgical System, requires dedicated ports for its specialized arms. A robotic hysterectomy typically involves four to six small incisions to accommodate the camera and the multiple instrument arms. Although this increases the number of cuts, the incisions remain small, and the enhanced dexterity and visualization offered by the robot can be beneficial for complex cases.
The Function of Each Incision Site
In a traditional multi-port laparoscopic hysterectomy, each incision serves a distinct purpose. The initial port is the camera port, used to insert the laparoscope and provide the operating team with a high-definition, magnified view of the internal anatomy. Before any instruments are inserted, carbon dioxide gas is pumped into the abdomen to create a working space, a process known as insufflation.
The remaining incisions are the working ports, which allow the surgeon to introduce the instruments needed for dissection, cauterization, and suturing. These tools are used to detach the uterus from its surrounding ligaments and blood supply.
Finally, one of the ports serves as the extraction site, though the uterus is most often removed through the vagina to avoid a larger abdominal incision. The careful placement of these ports ensures that the surgical instruments can work together without clashing, allowing the surgeon to operate with precision.
Immediate Care and Appearance of the Incisions
The small size of the laparoscopic incisions contributes to minimal post-operative scarring and faster recovery. The tiny cuts are closed using methods designed to promote healing and minimize visible marks. This often includes dissolvable sutures beneath the skin, surgical glue applied externally, or small strips of specialized tape called Steri-Strips.
Immediately after surgery, the sites appear as small, red marks, and some bruising is normal. Patients should keep the areas clean and dry, washing gently with mild soap and water. Avoiding hydrogen peroxide or alcohol is advised, as these can impede the natural healing process. Over time, the incisions typically fade significantly, especially the one hidden within the navel.