Laparoscopic Assisted Vaginal Hysterectomy
Not your mother's hysterectomy.
Past and Present:
Laparoscopic Assisted Vaginal Hysterectomy (LAVH) is not your mother’s hysterectomy. In the old days, you stayed in the hospital for 4-6 days, didn’t return to work for 6 weeks, and were left with a large scar. Today, there are a number of new options that do away with those problems and more. New procedures feature shorter or no hospital stays, less post-operative pain, negligible scars, and a quick return to normal activity and work.
The Laparoscopic Revolution:
Laparoscopy was pioneered by gynecologists in the early 1960s, and has been widely used in a range of procedures, including tubal ligation, the removal of ovaries and fibroids (benign fibrous tumors of the uterus), and the treatment of tubal pregnancies.
If you’re concerned that laparoscopic hysterectomy is relatively new, remember that gynecologists have been using laparoscopy for the past three decades. More than 95 of all gallbladder surgery is now performed using this technique. Similarly, LAVH is rapidly gaining acceptance among gynecologic surgeons and their patients.
The first laparoscopic hysterectomy in the world was performed by gynecologist Dr. Harry Reich in 1989. Dr. Lyndon Taylor at Healthcare for Women has been performing this procedure since 1991.
LAVH combines laparoscopy and hysterectomy. Laparoscopy is used to look into the abdomen at the reproductive organs. Hysterectomy is surgery to remove the uterus.
The uterus can be removed in two ways. When it is removed through a large cut (incision) in the abdomen, the procedure is called an abdominal hysterectomy (the past).
Today, LAVH involves the use of a small, telescope-like device called a laparoscope. The laparoscope is inserted into the abdomen through a small cut. It brings light into the abdomen so that your doctor can see inside. Tiny instruments are also inserted to perform the procedure. Ligaments that support the uterus are cut with these instruments, and the uterus is removed vaginally.
The benefits of LAVH include a short post-operative recovery time, which can be as little as a few hours after the surgery, to a day or two depending on your condition. Also, many patients can return to work and normal activities within 1 to 2 weeks. Most patients appreciate that LAVH has better cosmetic results, with only tiny scars.
What To Expect:
LAVH may be performed on an out-patient basis. This means that you may be going home the same day. The surgery typically lasts from 1 to 2 hours, with a 4- to 8-hour post-operative recovery period, depending on your condition.
A complete history and physical exam including a pap smear and a vaginal ultrasound are performed at the time of the first visit, with other pre-surgical testing depending on your condition. You do not qualify for LAVH if you have advanced cancer.
Recovery from laparoscopic surgery is significantly faster and less painful than recovery from traditional surgery. After LAVH, you will no longer have any vaginal bleeding. There wil be no hormonal changes when the ovaries are preserved. Most women say that sex is unchanged, or even improves because of the elimination of bleeding and pain. You may experience some vaginal dryness, which can be treated with estrogen cream and lubricants (we recommend Astroglide).
Comparative Benefits of Laparoscopic Supracervical Hysterectomy
|Procedure||Total Abdominal Hysterectomy||Vaginal
|Laparoscopically Assisted Vaginal Hysterectomy||Laparoscopic
|Incision Site||Abdomen||Inner vagina||Belly button/vagina||Abdomen (4 small incisions|
|Hospital Stay||5-6 days||1-3 days||1-3 days||Outpatient to 1 day|
|Recovery Time||6 weeks||4-6 weeks||4-6 weeks||2-3 weeks|
|Retention of Cervix||Upon request||No||No||Yes|
|Indications||AUB*, large fibroids, severe endometriosis, pelvic infection/scarring||AUB*, utero-vaginal prolapse, smaller fibroids||AUB*, utero-vaginal prolapse, smaller fibroids||AUB*, fibroids|
|Contraindications||Large fibroids||Large fibroids||Large or numerous fibroids|
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