Laparoscopic Vaginal Hysterectomy

What Is Laparoscopic Vaginal Hysterectomy?

Laparoscopic assisted vaginal hysterectomy (LAVH) or laparoscopic vaginal hysterectomy is the surgical removal of the uterus through the vagina with the aid of a viewing tube inserted through small incisions in the abdomen. The uterus may be removed alone or with the fallopian tubes and ovaries.

The laparoscope is a tiny camera attached to a long thin tube that can take images of the pelvic organs while being viewed by the obstetrician on an external monitor. It is inserted through a small cut near the navel and used while the obstetrician manipulates the uterus through another small (one to two cm) skin incision on the abdomen. The uterus is then detached from its ligaments and blood supply using thin instruments inserted near the navel. If the fallopian tubes and ovaries are meant to be removed, they are also detached from the ligaments and blood supply. The freed organs are then passed and removed through the vaginal canal. After bleeding from the incisions and sites of detachments are controlled, tissues are sutured and the tiny abdominal cuts are closed.

Advantages of Laparoscopic Assistance

A hysterectomy is often done because of fibroids in the uterus, endometriosis, uterine prolapse, cancer of the uterus, abnormal uterine bleeding and chronic pelvic pain. Of these, benign fibroids in the uterus are the most common cause of vaginal hysterectomy.

Although surgical removal of the uterus may be done by the abdominal route, vaginal hysterectomy with laparoscopic assistance has its advantages:

• Smaller incisions mean less trauma to the skin and tissues
• Less bleeding
• Less risk for infections
• Less post-operative pain and scarring
• Shorter hospital stay
• Faster recovery and return to normal activity

Disadvantages of LAVH

Since a transvaginal procedure is more technologically complicated in that the obstetrician will be working in a limited space, the procedure takes a longer time to accomplish. This puts the patient under anesthesia for a longer period of time which may result in some complications. The risk for urinary bladder injury is also higher because of its proximity to the uterus.

Recovery After Laparoscopic Vaginal Hysterectomy

After surgery the patient is allowed to recover from the effects of anesthesia in the recovery room (post-anesthesia care unit). If there are no complications she is transferred to her suite where she is advised to get up and walk as soon as she can. This will help increase gastrointestinal motility and prevent bloating. It also helps prevent blood pooling and clotting in the legs.

Pain relievers and antibiotics are given as indicated by protocol. After LAVH hospital stay is short (a few days) and the patient is allowed to go home with medicine prescriptions and instructions.

The patient is advised to rest and avoid carrying or lifting heavy objects. She may need to wear sanitary pads since vaginal bleeding and discharge may occur for a few weeks. She must also avoid using tampons or having sex for a while. Immediate medical consultation must be done if the patient experiences severe pain or heavy bleeding at home. Gynecologic follow up and gradual return to normal activities are advised.

References

ACOG, “Hysterectomy”, https://www.acog.org/publications/patient_education/bp008.cfm

MedicineNet, “Laparoscopically Assisted Vaginal Hysterectomy (LAVH)”, https://www.medicinenet.com/laparoscopically_assisted_vaginal_hysterectomy/article.htm