Hysterectomy with BSO
in Bangkok, Thailand
Bilateral Salpingo-oophorectomy (BSO)
Hysterectomy and oophorectomy that may be performed to reduce gender dysphoria are gynecological procedures which can be achieved by laparoscopic surgery (minimally invasive surgery) or open technique (abdominal hysterectomy).
1. Laparoscopic technique:
Instead of making a large incision, the new only makes a few tiny incisions through which thin instruments are passed. This new technique significantly reduces scaring, pain, healing time, blood loss and duration of hospital stay when compared to open technique.
Picture 1 shows the scar of laparoscopic hysterectomy technique
2. Abdominal Hysterectomy with Bilateral Salpingo-oophorectomy (BSO) or Open Technique
A transverse incision is made through the abdominal wall, usually above the pubic bone, as close to the upper hair line of the individual's lower pelvis as possible, similar to the incision made for a caesarean section approximately 4-5cm long. This technique allows surgeon the greatest access to the reproductive structures and is normally done for removal of the entire reproductive complex. Abdominal hysterectomy is the most common method. The recovery time for an open hysterectomy is 4–6 weeks.
Picture 2 shows the scar of abdominal hysterectomy or open technique
3. Subsequently the Vaginal or V technique:
Vaginal hysterectomy is performed entirely through the vaginal canal and has clear advantages over abdominal surgery such as less complications, shorter hospital stays and shorter healing time. When this technique has complications, a surgical exploration is required.
Risks and complications:
1. Wound complication, such as infection, abscess, disruption
2. Excessive bleeding.
3. Bladder, ureter or bowel injury
4. Temporary abdominal distention due to transient decreased bowel movement
4. Natural Orifice Transluminal Endoscopic Surgery Hysterectomy with Bilateral Salpingo-oophorectomy (BSO) & Oophorectomy
This is a new technique to remove uterus and ovaries, developed from total laparoscopic hysterectomy and transvaginal hysterectomy procedures, which provides more safety. During the operation, the surgeon inserts vaginal speculum into the vagina and inserts the shield into the vagina to protect the cervix. Then the surgical instrument is inserted into vagina. After dissection, both uterus and ovaries are removed from the vagina opening.
1. No scar
2. Less postoperative pain
3. Shorter hospital stay and quick recovery of bowel function
4. Shorter recovery and quicker return to daily activities
5. Less complication from bleeding during surgery or less chance of injury in the abdomen
Picture 3 shows the scarless of NOTES technique