A laparoscopic hysterectomy (LH) represents a minimally invasive method for removing the uterus. This procedure is a modern alternative to traditional open surgery, which requires a large incision in the abdomen. LH utilizes specialized instruments and a camera inserted through several small cuts, often called “keyhole” incisions, to complete the operation. This technique allows the surgeon to visualize the internal pelvic organs on a monitor, enabling precise detachment and removal of the uterus. The approach is associated with benefits including reduced recovery time, less post-operative discomfort, and smaller scars.
The Number and Size of Incisions
A standard laparoscopic hysterectomy typically involves three to four separate incisions to establish access points for surgical tools. These cuts are significantly smaller than the single, long incision required for an open abdominal hysterectomy. The size of these ports generally ranges from 5 millimeters to 12 millimeters in diameter. The majority of these ports are 5 millimeters wide, accommodating instruments for grasping, cutting, and coagulation. A slightly larger incision, often 10 or 12 millimeters, is necessary for the camera and for the eventual removal of the uterus specimen.
Specific Anatomical Placement
The primary incision site for a laparoscopic hysterectomy is most frequently located at the umbilicus, or belly button. This central location is preferred because the natural crease of the navel helps conceal the resulting scar and provides a direct entry point to the abdominal cavity. This entry point can be made either directly in the navel or along its rim, depending on the surgeon’s preference.
The secondary, or accessory, incisions are placed strategically in the lower abdomen to create optimal angles for the surgical instruments. Typically, two or three additional ports are situated in the bilateral lower quadrants. This placement allows the instruments to approach the uterus from the sides, facilitating necessary dissection and detachment. Surgeons carefully select these accessory sites to remain lateral to the inferior epigastric vessels, which run vertically down the front of the abdomen, preventing injury and bleeding. In some cases, a fourth port may be placed in the midline, a few centimeters above the pubic bone, depending on the complexity of the case.
The Purpose of Each Surgical Port
Each incision, or port, serves a specific function during the operation. The incision at the umbilicus is the primary entry point for the laparoscope, a long, thin tube equipped with a camera and a light source. This camera transmits a high-definition image of the pelvic organs to a monitor, allowing the surgeon to see the surgical field and perform the procedure remotely.
The smaller, accessory ports in the lower abdomen introduce the specialized surgical instruments needed to perform the hysterectomy. These instruments include graspers for holding tissue, scissors for cutting, and devices for coagulation and sealing blood vessels. One of these lateral ports, often the 10 or 12-millimeter opening, is designated as the retrieval site. This slightly larger opening is necessary because the uterus, once detached, is either removed through the vagina or morcellated (cut into smaller pieces) and extracted through this abdominal port.
Post-Operative Appearance of Incisions
The small incisions are closed using various methods to promote optimal healing and minimize scarring. Common closure techniques include absorbable sutures placed beneath the skin, surgical glue, or small adhesive strips known as steri-strips. Since the cuts are typically between 0.5 and 1 centimeter, tissue trauma is minimal, which contributes to a faster recovery of the incision sites. The final appearance of the wounds is characterized by minimal scarring compared to the lengthy scar from an open abdominal hysterectomy. The incision placed in the navel is often nearly invisible after healing because the scar tissue forms within the natural folds of the umbilicus.