Vaginal Hysterectomy Assisted With Laparoscopy

Definition of Vaginal Hysterectomy Assisted With Laparoscopy

A vaginal hysterectomy involves the removal of the uterus and cervix through the vagina. A laparoscope is a small tube with a light and camera at one end. It 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.

Who is a candidate for the procedure?

A laparoscopically assisted vaginal hysterectomy (LAVH) may be used for the following conditions:

• abnormal cells in the lining of the uterus or cervix that are suspicious for very early cancer
• abnormal or heavy bleeding from the uterus
• adenomyosis, or non-cancerous tumors made of gland tissue and muscle
• chronic pelvic pain
• endometriosis, a condition in which small pieces of the uterus lining attach to tissue outside the uterus
• fibroids, which are non-cancerous tumors that grow in the muscle of the uterus
• pelvic inflammatory disease, or widespread infection of the pelvic organs

How is the procedure performed?

Before surgery, several things are usually done.

• An anesthesiologist meets with the woman. He or she will discuss the anesthesia options and check for any allergies to medicines.
• An intravenous line (IV) is placed in a vein, usually in the hand or arm. The IV can be used to replace fluids and give medicine or a blood transfusion.
• Medicines, such as sedatives, are given.

In the operating room, the abdomen and vulvar area, which is the area between the legs, are sometimes shaved. A urinary catheter is placed in the bladder to drain urine.

A small incision is made below the navel to place the laparoscope. The abdomen is then inflated with gas so that the surgeon can see clearly inside the body. Other surgical tools are placed through two 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 before the uterus is removed.

The uterus is then removed through the vagina. The vagina is closed with sutures 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.

What happens right after the procedure?

The woman usually stays in the hospital for 1 to 2 days. She may be asked to sit up in bed and walk a short distance the first night after surgery. The urinary catheter is usually removed the next morning. The IV is usually removed if there is no evidence of fever or infection and the woman is drinking fluids.

What happens later at home?

Women having this surgery are advised to follow certain directions at home.

• Antibiotics and pain medicines should be taken as directed if needed.
• A balanced diet with iron replacement should be followed to promote healing.
• Exercise programs should be followed as directed.
• Intercourse should be avoided for 4 to 6 weeks after surgery to allow the vagina and internal structures to heal.
• Stool softeners, such as docusate (i.e., Colace), should be used. The woman should drink eight glasses of fluids each day. This helps prevent constipation and straining and damage to the incision.
• Heavy lifting should be avoided for 4 to 6 weeks.
• Walking every day is recommended.

The results of surgery often depend on what caused the problem. Removing the uterus ends abnormal uterine bleeding and pelvic pressure. Some other conditions, such as cancer, may come back.

After a hysterectomy, a woman cannot become pregnant and does not have any more periods. If the ovaries are removed along with the uterus, estrogen replacement therapy may be advised. This helps prevent symptoms and other health problems of menopause.

What are the potential complications after the procedure?

Surgery may be complicated by bleeding, infection, damage to surrounding tissues such as the bowel or bladder, or a reaction to the anesthetic. Any new or worsening symptoms should be reported to the healthcare professional.