Laparoscopically Assisted Vaginal Hysterectomy (LAVH) is a surgical procedure for uterus removal. This minimally invasive approach combines laparoscopic and vaginal surgery techniques. It offers an alternative to traditional, open abdominal hysterectomies, addressing various gynecological conditions.
Understanding LAVH and its Purpose
LAVH integrates two distinct surgical approaches. It involves the use of a laparoscope, a thin, lighted tube with a camera, inserted through small abdominal incisions, to guide the initial stages of the surgery. The uterus is then removed through the vagina, avoiding a large abdominal incision.
This method is chosen for women experiencing medical conditions requiring a hysterectomy. Common indications include abnormal uterine bleeding that hasn’t responded to other treatments, uterine fibroids, and endometriosis. Uterine prolapse, where the uterus descends into the vagina due to weakened supporting tissues, is another reason for considering LAVH.
Chronic pelvic pain, particularly when it originates from the uterus and has not been alleviated by other interventions, can also lead to an LAVH. The procedure may also involve removing the fallopian tubes and/or ovaries, depending on the patient’s health needs. This integrated technique allows for removal of structures difficult to access through a purely vaginal approach.
The Surgical Procedure
The LAVH procedure begins with the patient under general anesthesia. The surgeon makes several small incisions in the abdomen. Through one of these incisions, a laparoscope is inserted, providing a magnified view of the pelvic organs on a monitor.
To create working space and enhance visibility, a harmless gas, usually carbon dioxide, is introduced into the abdominal cavity. Additional small incisions are then made to allow for the insertion of specialized laparoscopic instruments. These instruments are used to detach the uterus from its supporting ligaments and blood supply.
Once the uterus is detached, it is removed through a vaginal incision. If the fallopian tubes and ovaries are also removed, this occurs at this stage. After the uterus is removed, the incisions in both the abdomen and vagina are closed with stitches.
Preparing for and Recovering from LAVH
Preparation for LAVH involves several steps to ensure a smooth procedure and recovery. Patients are typically advised to stop eating and drinking for 6 to 12 hours before surgery. Adjustments to medications, such as stopping blood thinners like aspirin or ibuprofen, may also be necessary to reduce the risk of bleeding. Pre-operative tests, including blood work and imaging, are often conducted a week or two prior to the surgery.
Following the surgery, patients are closely monitored in a recovery room. A short hospital stay, often ranging from same-day discharge to one or two days, is common for LAVH. Pain management is provided, and patients may experience mild cramping, bloating, or shoulder pain due to the gas used during the procedure.
Recovery at home typically involves a gradual return to normal activities. Light vaginal bleeding or discharge is common for several weeks, and patients are advised to use sanitary pads instead of tampons. While heavy lifting and strenuous exercise should be avoided for several weeks, gentle walking is encouraged to aid circulation and recovery. Most individuals can return to work and resume light activities within 1 to 2 weeks, with a full recovery often taking about 4 to 6 weeks.