Laparoscopically Assisted Vaginal Hysterectomy (LAVH) is a procedure using laparoscopic surgical techniques and instruments to remove the uterus (womb) and/or tubes and ovaries through the vagina (birth canal).
Its greatest benefit is the potential to convert what would have been an abdominal hysterectomy into a vaginal hysterectomy. An abdominal hysterectomy requires both a vaginal incision and a four to six inch long incision in the abdomen, which is associated with greater post-operative discomfort and a longer recovery period than for a vaginal procedure. Another advantage of the LAVH may be the removal of the tubes and ovaries which on occasion may not be easily removed with a vaginal hysterectomy.
This does not mean that all hysterectomies could or should be done by LAVH. There are certain conditions that will necessitate abdominal or vaginal hysterectomy. In fact a vaginal hysterectomy by itself, if indicated, is less time consuming, less expensive, and can be less dangerous. When LAVH is performed, several small abdominal incisions are made. Through these small incisions slender metal tubes known as “trocars” are inserted. They provide passage for a laparoscope (which is like a tiny telescope) and other microsurgical tools.
A camera attached to the laparoscope provides a continuous image that is magnified and projected onto a television screen. It provides the view by which the surgeon operates.
The uterus is detached from the ligaments that attach it to other pelvic structures using laparoscopic tools, electro-coagulation or a laser. Adhesions may have to be freed and, if the tubes and ovaries are to be removed, they are detached from their ligaments and blood supply. They then can be removed with the uterus through an incision made in the vagina. Since the incisions are small, the scarring and pain from LAVH is often less than that associated with abdominal hysterectomy.
Hysterectomy is the second most frequently performed surgery in the United States. As with any surgical procedure, the decision to undergo a hysterectomy should not be taken lightly. You should discuss this thoroughly with your doctor.
The most common medical reasons for performing hysterectomies include uterine fibroids (30 percent of cases), abnormal uterine bleeding (20 percent), endometriosis (20 percent), genital prolapse (15 percent), and chronic pelvic pain (about 10 percent). For most of these conditions, other treatments should first be considered, and hysterectomy should be reserved as a last resort.
Single, free copies of Understanding Hysterectomy (AP008) are available by sending a stamped, self-addressed, business-size envelope along with the name of the booklet to: The American College of Obstetricians and Gynecologists, Resource Center, 409 12th Street, SW, Washington, DC 20024.