Alternative Names laparscopically assisted vaginal hysterectomy, laparascopic removal of the uterus, LAVH
Definition This surgery removes the uterus and cervix through the vagina using a laparoscope. A laparoscope is a small tube with a light and camera at one end. This allows the surgeon to see the inside of the pelvic cavity without making a big cut in the skin. The ovaries and fallopian tubes may also be removed in this procedure. This type of surgery allows for faster healing and smaller scars than older methods.
Who is a candidate for the procedure? This procedure may be used for the following problems:
abnormal or heavy bleeding from the uterus
fibroids, which are noncancerous tumours that grow in the muscle of the uterus
adenomyosis, or benign tumours made of gland tissue and muscle
uterine prolapse, which is when the uterus falls from its normal position
How is the procedure performed? Before surgery:
An IV is placed in the hand or arm. This allows fluids, medication or a blood transfusion to be given if needed.
A tube called a catheter is placed into the bladder. This allows the doctor to see how much urine the woman is making. It also drains the bladder through the night so that a woman does not have to get up to go to the bathroom
Blood tests are done.
An anaesthetist, who is doctor trained to give medications during surgery, meets with the woman. He or she will discuss allergies to medication and other disorders, if there are any. The method of pain control is also discussed.
The belly and vulvar area, which is the area between the legs, is sometimes shaved.
Medications needed before surgery are given.
In the operating room, the woman is given pain medication and may even be put completely to sleep to prevent her from feeling pain. The skin around the vulva and vagina is then cleaned well to kill any bacteria.
A small cut is made below the belly button to place the laparoscope. The stomach is then inflated with gas so that the surgeon can see clearly inside the body. Other surgery tools are placed through two other small cuts in the lower part of the belly. These are used to cut the tissues, such as blood vessels. that surround the uterus and cervix. These tissues must be cut and tied off to remove the uterus. The uterus is then removed through the vagina. The vagina is closed with stitches at the top.
The surgery usually takes 60 to 90 minutes. At times, the ovaries and tubes or other structures may be removed or repaired during the procedure. All tissue is sent to a laboratory to be analysed.
What happens right after the procedure? The woman usually stays in the hospital for 1 to 5 days. She may be asked to sit up in bed and walk a short distance the first evening after surgery. The catheter is usually removed the next morning if no bladder repair or trauma occurred. The IV is usually removed if there is no evidence of fever or infection, and the woman is able to drink fluids without getting nauseous or vomiting.
The results of surgery often depend on what caused the problem. Problems such as endometriosis or pelvic adhesions may recur. Removing the uterus ends abnormal uterine bleeding, pelvic pressure, and removes fibroids. After this operation, a woman does not need to use birth control since she cannot become pregnant. If the ovaries are removed along with the uterus and cervix, hormone replacement therapy with oestrogen is often advised after surgery. This helps prevent symptoms of menopause.
What happens later at home? Women having this surgery are advised to follow these tips at home:
A balanced diet with iron replacement should be followed to promote healing.
Stool softeners should be used and 8 glasses of fluids should be taken in each day. This helps prevent constipation and straining during bowel movements, which may disturb the healing wounds.
Heavy lifting should be avoided for 4 to 6 weeks.
Walking is advised every day.
Antibiotics and pain relievers should be taken as directed if needed.
Exercise programs should be followed as directed.
Sex should be avoided for 4 to 6 weeks after surgery to allow the vagina and internal structures to heal.
What are the potential complications after the procedure? The risks and benefits of any surgery should be discussed with the women's doctor before the operation. Possible problems include:
infection
those caused by anaesthesia, such as breathing trouble, reactions to drugs and poor pain relief
internal bleeding
mild nausea and vomiting
trauma to the bladder or ureter, the tube that carries urine from the bladder to the outside of the body
bowel trauma
fistula formation, which occurs when a hole forms between the bladder, intestines and vagina
pelvic scar formation
prolonged paralysis of the bowels
allergic reactions to antibiotics or pain medication
bleeding, which may require blood transfusions
stitches breaking apart
blood collecting below the cut
blood clots in the legs, lungs, heart or brain
death
Most women, however, have few or no complications.
Author: Eva Martin, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
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