Laparoscopic-assisted vaginal hysterectomy (LAVH) is a surgery that uses laparoscopy or small holes with instruments or cameras in the abdomen and an incision in the vagina to remove the uterus. Though still a relatively new surgery, the development of LVAH has been welcomed. It makes it possible to perform vaginal hysterectomy on a greater number of patients. It is also associated with fairly minimal scarring, and less pain and complications, plus faster post-operative recovery time.
In an abdominal hysterectomy, the uterus is removed through an incision in the abdomen, while with a vaginal hysterectomy, the uterus is removed through an incision inside the vagina. This surgery isn’t appropriate if a patient has conditions like endometriosis, fibroids, a very large uterus, or if the ovaries and fallopian tubes are also being removed.
To address these issues, surgeons developed laparoscopic-assisted vaginal hysterectomy, which has broader applications, but still the benefits of minimal scarring and quicker recovery time. The ability to remove the uterus vaginally is made possible or assisted by cutting several very small holes in the abdomen into which a variety of tools like a camera for better visualization or cutting devices and clamps can be inserted. These help to visualize or address some of the problems where the uterus sits, clearing the field for any cutting of tissue that is necessary or making it possible to more easily remove the uterus from below.
While laparoscopic incisions will leave small scars, they are very small as compared to a laparotomy or incision in the abdomen. The other area of incision, from inside the vagina is not visible and won’t produce visible scarring. Incision in the vagina can still bleed a little or produce a small amount of discharge in early post-operative days, but this is thought minimal as compared to abdominal hysterectomy. Recovery time from a laparoscopic-assisted vaginal hysterectomy is often greatly reduced, and many women are able to resume normal activities within a few weeks of the surgery.
There may be different guidelines that hospitals follow in determining recovery time from a laparoscopic-assisted vaginal hysterectomy. Sometimes this procedure is performed outpatient, and other times women spend one or two days recovering in the hospital prior to going home. The surgery is usually performed under general anesthesia, but it might also be possible to use a combination of local anesthesia and sleeping sedation.
Even though laparoscopic-assisted vaginal hysterectomy makes it possible to perform vaginal hysterectomy in more instances, there are a still cases where LAVH isn’t appropriate. If cancer is present, a laparotomy is preferred, and during an LAVH the procedure might be converted to abdominal removal due to excess bleeding or complications. Some surgeons prefer the open hysterectomy, and in cases of emergency, an abdominal uterine removal might be preferenced because it can be performed quickly. Those with advance notice of need for hysterectomy can discuss with their physicians the most appropriate surgery method.