The female reproductive system consists of the uterus, the fallopian tubes and the ovaries.
The uterus is located in the pelvis between the bladder and the rectum and is a hollow muscular organ – typically weighting 50-100 gr and measuring 7.5 cm long, 5 cm wide and 3 cm thick – that looks like with inverted pear and consists of the cervix, fundus, corpus (body) and the internal os. The main body of the uterus includes the perimetrium – the outer layer, the myometrium that is the main part and the interior called the endometrium. The main purpose of the uterus is to nourish the fetus and protect its development until birth.
The fallopian tubes or oviducts are two fine muscular elongated tubes 10-13 cm long with an outer diameter of 0.05-1.0 cm. The fallopian tubes can be described in four parts: the Fimbriae, the Infundibulum, the Ampulla and the Isthmus. The fallopian tubes enable the passage of egg cells from the ovaries to the uterus.
The ovaries are a pair of tiny genital glands in the female pelvic cavity. They are the most important organs of the female reproductive system, since they have a dual role of both producing female sex hormones and the female gametes that are fertilized to form embryos. The ovaries are oval-shaped, 3-5 cm long, 1.5-3 cm wide and 1.5-2.5 cm thick. Their color is pinkish-gray and their surface is irregular and scarred. The ovaries are located on opposite sides of the uterus in the pelvic cavity and are attached to the uterus by the ovarian ligament.
In cases where ovarian cysts, long-term pelvic pain, non-cancerous tumors (fibroids), heavy periods, endometriosis, cervical malformations (CIN) or uterine, ovarian and cervical cancer (stage I) or cancer of the fallopian tubes are diagnosed, the surgical procedure of choice is the Laparoscopic Hysterectomy.
The uterus – and surrounding tissues if needed- are removed through three or four small incisions in the abdomen from where a camera and the laparoscopic tools are inserted.
There are several types of Laparoscopic Hysterectomy, with the main being the following:
- Total Laparoscopic Hysterectomy with salpingo-oophorectomy: the womb, cervix, fallopian tubes and the ovaries are removed. The salpingo-oophorectomy could be bilateral or unilateral.
- Total Laparoscopic Hysterectomy– the womb and cervix are removed
- Subtotal Laparoscopic Hysterectomywith bilateral salpingo-oophorectomy: the main body of the womb, the fallopian tubes and the ovaries are removed, while the cervix is left in place
- Subtotal Laparoscopic Hysterectomy: the main body of the womb is removed, leaving the cervix in place
- Laparoscopically Assisted Vaginal Hysterectomy (LAVH): the uterus is detached from the ligaments that attach it to other structures in the pelvis using the laparoscopic tools. If the Fallopian tubes and ovaries are to be removed, they are also detached from their ligaments and blood supply. The organs and tissue are then removed through an incision made in the vagina.
Laparoscopic Hysterectomy is advantageous compare to Open Hysterectomy since it offers less blood loss, smaller surgical trauma, and thus less hospitalization days, faster recovery and a better aesthetic result.