Hysterectomy

Having performed laparoscopic surgery for over 20 years, Mr. Trehan is one of the most experienced laparoscopic surgeons in the country. Mr Trehan is a hysterectomy specialist, and undertakes all hysterectomies by laparoscopic (keyhole) surgery with just an overnight stay in the hospital, a service he pioneered in 1998 which was the first of its kind and gained national recognition. Mr. Trehan’s complication rates are amongst the lowest reported in the medical literature, and patients frequently travel from across the world in order to have hysterectomy surgery by Mr. Trehan.

A hysterectomy is a procedure in which the uterus is removed. It may be performed for a variety of reasons including uterine fibroids (although a myomectomy may be opted for if pregnancy is desired), adenomyosis, endometriosis (although Mr. Trehan aims to preserve the uterus in all cases of endometriosis and only performs a hysterectomy in instances in which child bearing is not require and the uterus is itself diseased with adenomyosis), uterine prolapse and chronic pelvic pain (although as a last resort only when all other options have been considered).

There are three principal means by which a hysterectomy may be performed:

• Open hysterectomy
• Vaginal hysterectomy
• Laparoscopic (keyhole) assisted vaginal hysterectomy

The open hysterectomy is by far the least desirable means by which a hysterectomy can be performed, as during this procedure a large cut is made in the abdomen and hence is associated with numerous disadvantages including slower recovery, more post-operative pain, increased risk of post operative infection and other complications as outlined on the other page on this website which explains and details the advantages of laparoscopic (keyhole) surgery.

During a vaginal hysterectomy, the uterus is detached and then removed through the vagina and no incision is made in the stomach.

During a laparoscopic (keyhole) assisted vaginal hysterectomy, tiny incisions are made in the stomach into which instruments are inserted and the uterus is then detached using these instruments and removed through the vagina.

Studies have demonstrated that laparoscopic (keyhole) assisted vaginal hysterectomy is associated with reduced risk of haematoma, blood loss, postoperative pain, and hospital stay when compared with vaginal hysterectomy, and furthermore laparascopic hysterectomy allows for the pelvic anatomy to be observed by the surgeon which may reveal further pathologies which may need treatment; which is not possible during vaginal hysterectomy. In addition, the removal of large uteri and the fallopian tubes/ovaries is much more difficult during vaginal hysterectomy than laparoscopic (keyhole) assisted vaginal hysterectomy. The video below demonstrates the advantages of keyhole (laparoscopic) hysterectomies over vaginal and abdominal hysterectomies. This was presented internationally at numerous conferences by Mr Trehan in 1998-2002 including:

• 8th Annual Congress of the International Society of Gynaecological Endoscopy, Montreal, Canada
• 28th British Congress of Obstetrics and Gynaecology, Harrogate, UK
• 1st International Congress of Gynaecological Endoscopy, Barcelona, Spain
• International society for Gynaecological and Endoscopy, Chicago, USA

For the reasons discussed above, Mr. Trehan performs all hysterectomies (apart from rare cases in which the uterus is larger than a uterus would be 28 weeks into pregnancy) as laparoscopic (keyhole) assisted vaginal hysterectomies. Mr. Trehan’s patients can be confident that their operation will be completed by keyhole means as Mr. Trehan’s conversion to laparotomy rate is amongst the lowest in the medical literature, as are his major complication rates, reoperation rates and readmission rates. Further, over 90% of Mr Trehan’s patients are able to leave the hospital after just an overnight stay in hospital.

Mr. Trehan was instrumental in pioneering the overnight hospital stay following keyhole hysterectomy in the United Kingdom and an article in the Daily Mail in 1998 published regarding Mr. Trehan’s keyhole hysterectomies can be read below:

View the scanned article
View the article on the Daily Mail website

In addition, two peer-reviewed journal papers which Mr. Trehan published regarding keyhole hysterectomies can be read below:

Hysterectomy – towards overnight stay
Laparoscopic assisted vaginal hysterectomy: a low complication hysterectomy