Laparoscopic hysterectomy is major surgery accomplished through minor incisions. Laparoscopy enables an abdominal hysterectomy to be converted into a procedure where a large abdominal cut (incision) is avoided.
A significant degree of controversy has surrounded the concept of utilising the laparoscope to assist with hysterectomy. The laparoscopic approach may be used to divide pedicles from above, avoiding a large incision and thus allowing the uterus to be removed from below.
This technique should not be used as an alternative to vaginal hysterectomy, but as a method to allow an abdominal hysterectomy to be converted to a vaginal hysterectomy, or to convert a difficult vaginal hysterectomy to an easy procedure.
In experienced hands the requirement for abdominal hysterectomy has now dropped considerably. The major drawback to laparoscopic hysterectomy is the difficult learning curve for the surgeon to acquire the necessary skills.
In experienced hands most hysterectomies can be performed without a large incision. Exceptions include cancer and the very large uterus (extending up to the umbilicus). The potential complications are similar no matter how the hysterectomy is done.
The laparoscopic approach has less infective complications and avoids the problems of a large cut (wound breakdown, hernia, infection etc).