Laparoscopic hysterectomy

Summary

A laparoscopic hysterectomy is an operation to remove the womb (uterus) through a few small cuts in the abdomen, using a thin camera and fine instruments, under general anaesthetic. It is usually recommended when heavy bleeding, fibroids, adenomyosis or other womb conditions have not responded to simpler treatments and you have completed your family.

• The operation usually takes 1–2 hours and most women go home the following day — some the same day.
• Most women are back to normal activity and routine work by the second week — faster than after open surgery.
• Periods stop permanently. Pregnancy is no longer possible. This is not reversible.
• Serious complications are uncommon; the main ones are bleeding, infection, blood clots and injury to the bladder, bowel or ureters.
• Whether your ovaries are removed at the same time is a separate decision made with you beforehand.

This information supports discussion with your healthcare team. Reading, saving or printing it does not constitute consent to surgery.

About the operation

A hysterectomy is removal of the womb. In a total laparoscopic hysterectomy (TLH) the womb and the cervix (the neck of the womb) are both removed. "Laparoscopic" — often called keyhole surgery — means the operation is done through three or four small cuts, each about 0.5–1 cm, rather than one long cut across the abdomen.

A thin telescope with a camera (a laparoscope) is passed through a cut near the navel, and the surgeon operates with fine instruments through the other cuts while watching a screen. The womb is freed from its attachments and removed through the vagina. The top of the vagina is then stitched closed; the vagina itself is not shortened in a way you would normally notice.

The fallopian tubes are usually removed at the same time (a salpingectomy), because this does not affect hormones and reduces the future risk of some ovarian cancers. Removal of the ovaries (oophorectomy) is a separate decision — see the consent discussion section.

Why it is performed

A hysterectomy is almost never the first treatment. It is usually considered when a womb condition significantly affects your life and simpler options — medicines, a hormonal coil (LNG-IUS), or less invasive procedures — have not worked, are unsuitable, or are not acceptable to you. Conditions it treats include:

• Heavy menstrual bleeding that has not responded to other treatment
• Fibroids causing bleeding, pressure or pain
• Adenomyosis (womb-lining tissue within the womb muscle)
• Endometriosis or long-standing pelvic pain, in selected cases
• Endometrial hyperplasia (thickening of the womb lining) and some early cancers, where specialist assessment recommends it

Because the womb is removed, it is only offered when you are sure your family is complete.

Benefits

What the operation is expected to achieve depends on why it is being done. Realistically:

• Heavy bleeding stops permanently. This is the one certainty of the operation — there are no further periods.
• Pressure and bulk symptoms from fibroids resolve once the womb is removed.
• Pain often improves but is not guaranteed to disappear, particularly where pain has more than one cause.
• Compared with open (abdominal) hysterectomy, the keyhole approach usually means less pain after surgery, a shorter hospital stay, smaller scars and a faster return to normal life.

Alternatives

Depending on your condition, the alternatives may include:

• No treatment now. Symptoms such as heavy bleeding often improve naturally at menopause; you can choose to wait, and change your mind later.
• Medicines — hormonal and non-hormonal tablets that reduce bleeding or pain.
• The hormonal coil (LNG-IUS) — often very effective for heavy bleeding, and reversible.
• Procedures that keep the womb — for example removal of fibroids only (myomectomy) or endometrial ablation for bleeding, in suitable cases.
• Other routes of hysterectomy — vaginal or open (abdominal) surgery may be recommended instead where the womb is very large or keyhole surgery is not suitable.

Your consultant will explain which of these are realistic options in your case, and why.

Preparing for surgery

Before the operation you will have a pre-operative assessment: blood tests, blood pressure checks, and a review of your medicines and general health. Tell the team about all medicines you take — some, such as blood thinners, need to be adjusted before surgery — and about any previous operations or anaesthetic problems.

• Smoking: stopping even a few weeks before surgery reduces chest and wound complications.
• Fasting: you will be given exact instructions on when to stop eating and drinking; typically no food from 6 hours before, water allowed up to 2 hours before.
• At home: arrange for someone to take you home and to help for the first few days. Prepare so that heavy lifting can be avoided for the first weeks.

The day of surgery

You will usually be admitted on the day of surgery. The team will confirm your identity and the planned operation, and you will meet the anaesthetist and the surgeon. This is the time for last questions — nothing is too small to ask.

You will be asked to sign the consent form, which records the operation, its intended benefits and its risks as they apply to you. You can still change your mind at this point. Compression stockings are usually fitted to reduce the risk of blood clots.

During the operation

The operation is done under general anaesthetic — you are fully asleep and feel nothing. Once you are asleep, the bladder is emptied, the abdomen is gently inflated with carbon dioxide gas to create working space, and the laparoscope and instruments are introduced through the small cuts.

The womb is freed from its blood vessels and supports, detached at the top of the vagina, and removed through the vagina. The vaginal top is closed with dissolvable stitches, the gas is released and the small cuts are closed. A laparoscopic hysterectomy usually takes about 1 to 2 hours; you will also spend time in the anaesthetic and recovery rooms either side.

Occasionally, if keyhole surgery proves unsafe to continue — for example because of unexpected scarring or bleeding — the surgeon completes the operation through a larger cut for your safety. This is uncommon.

After the operation

You will wake in the recovery room, sometimes with a drip; you leave theatre without a urinary catheter. Some shoulder-tip pain is common for a day or two — it comes from the gas used during surgery and settles on its own.

• Pain relief: regular simple painkillers control most discomfort; stronger medication is available if needed.
• Eating and drinking: usually the same day, starting with fluids.
• Moving: you will be encouraged to get up and walk early — it speeds recovery and protects against clots.
• Going home: most women go home the following day; some the same day.
• Bleeding: light vaginal bleeding or discharge for up to 4–6 weeks is normal while the internal stitches heal.

Recovery at home

Recovery is gradual and varies from woman to woman. As a general guide:

• Week 1: rest with gentle activity — short walks, light lifting is fine. Tiredness is normal and expected.
• Week 2 onwards: most of Dr Mathota's patients are back to normal activity and routine work by the second week; build up steadily as you feel able.
• Driving: usually after 2 weeks — when you can wear a seatbelt comfortably and perform an emergency stop without hesitation. Check your insurer's policy.
• Strenuous exercise and heavy physical work: usually from 3–4 weeks, guided by comfort.
• Sex: wait until vaginal discharge has stopped and you feel comfortable — usually around 6 weeks — to let the vaginal stitches heal.

These are typical figures for keyhole surgery; your own advice may differ and comes first.

Risks and complications

Every operation carries risk. The figures below are averages from published UK guidance; your individual risk depends on your health, weight, previous surgery and the reason for the operation, and will be discussed with you.

Expected, temporary effects

• Pain and tiredness in the first weeks; shoulder-tip pain from the gas for a day or two
• Light vaginal bleeding or discharge for up to 4–6 weeks
• Bruising around the small cuts

Complications

• Infection — of the urine, chest, wounds or vaginal top — is the most frequent complication; most cases are minor and settle with antibiotics (common: affects more than 1 in 100 women).
• Bleeding heavy enough to need a blood transfusion (uncommon: around 1 in 100 or fewer).
• Injury to the bladder, ureters or bowel — recognised injuries are repaired, sometimes needing further surgery (uncommon: fewer than 1 in 100).
• Blood clots in the leg or lung (VTE) — preventive measures are routine (uncommon).
• Conversion to open surgery during the operation, for safety (uncommon).
• Later problems — the vaginal top healing slowly or opening (rare), hernia at a cut site (rare), or a change in bladder or bowel habit.
• Anaesthetic risks — serious anaesthetic complications are rare in otherwise healthy women; the anaesthetist will discuss anything specific to you.

If your ovaries are removed and you have not reached menopause, menopause starts immediately after surgery — this has its own effects and options (including HRT) and is discussed separately before you decide.

When to seek help

After you go home, seek medical advice the same day if you notice:

• Heavy vaginal bleeding — bright red, or soaking a pad in an hour
• Fever (38 °C or higher) or feeling increasingly unwell
• Worsening abdominal pain not controlled by your painkillers
• A wound that becomes red, swollen, hot or leaks fluid
• Burning on passing urine, or being unable to pass urine
• A painful, swollen or red leg

Preparing for your consent discussion

Consent is a conversation, not a signature. Before agreeing to surgery you should feel you understand why this operation is recommended for you, what the realistic alternatives are, and which risks matter most in your case. The checklist below is a starting point — print it and bring it to your consultation.

Sources and review

This page was drafted against the published guidance below and reviewed by the consultant. Risk figures follow published RCOG/NICE averages.

1. Royal College of Obstetricians and Gynaecologists. Laparoscopic hysterectomy — consent advice. London: RCOG. Available from: https://www.rcog.org.uk/guidance/browse-all-guidance/consent-advice/ [last checked 27 July 2026].
2. National Health Service (UK). Hysterectomy. Available from: https://www.nhs.uk/tests-and-treatments/hysterectomy/ [last checked 27 July 2026].
3. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. NICE guideline NG88. Available from: https://www.nice.org.uk/guidance/ng88 [last checked 27 July 2026].
4. Royal College of Obstetricians and Gynaecologists. Recovering well after a laparoscopic hysterectomy (patient information). Available from: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ [last checked 27 July 2026].

Further reading from Sugabi Clinic and vog.lk

1. Sugabi Clinic Ragama. Laparoscopic hysterectomy — the surprising benefits of a smaller incision. Available from: sugabi.lk/blog/333
2. Sugabi Clinic Ragama. TLH — laparoscopic hysterectomy: faster recovery, less pain. Available from: sugabi.lk/blog/384
3. vog.lk — patient information articles by Dr Chaminda Mathota. Available from: https://vog.lk/