Laparoscopically Assisted Vaginal Hysterectomy
What is a hysterectomy?
A hysterectomy is the removal of the uterus (womb). For certain conditions, the Fallopian tubes and ovaries are simultaneously removed.
The most common medical reasons for doing a hysterectomy include benign fibroid tumors of the uterus (30% of cases), abnormal uterine bleeding (20%), endometriosis (20%), genital prolapse (15%), and chronic pelvic pain (about 10%). Some women choose to have a hysterectomy for other reasons, including other types of tumors. Uterine cancer is an uncommon, but important reason for doing a hysterectomy.
What is a laparoscope?
A laparascope is a viewing tube through which structures within the abdomen and pelvis can be seen. A small surgical incision (cut) is made in the abdominal wall to permit the laparoscope to enter the abdomen or pelvis. Additional tubes can also be pushed through the same incision allowing the introduction of probes and other instruments. In this way, surgical procedures can be performed without the need for a large surgical incision.
What is laparoscopically assisted vaginal hysterectomy?
Laparoscopically assisted vaginal hysterectomy (LAVH) is a surgical procedure using a laparoscope to remove the uterus and/or Fallopian tubes and ovaries through the vagina (birth canal). (A different procedure, called a laparoscopic hysterectomy, is entirely performed through the laparoscope and the uterus, tubes etc. are removed in tiny portions.)
Not all hysterectomies can or should be done by LAVH. There are certain conditions that necessitate an abdominal hysterectomy or a vaginal hysterectomy (without laparoscopy).
How is LAVH performed?
During LAVH, several small incisions (cuts) are made in the abdominal wall through which slender metal tubes known as "trocars" are inserted to provide passage for a laparoscope and other microsurgical tools. The laparoscope acts as a tiny telescope. A camera attached to it provides a continuous image that is magnified and projected onto a television screen for viewing.
In the course of LAVH, the uterus is detached from the ligaments that attach it to other structures in the pelvis using the laparoscopic tools. If the Fallopian tubes and ovaries are to be removed, they are also detached from their ligaments and blood supply. The organs and tissue are then removed through an incision made in the vagina.
What are the disadvantages of LAVH?
LAVH can be a longer operation and more expensive than a vaginal hysterectomy and, under certain circumstances, it can be more dangerous.
What are the advantages of LAVH?
The incisions in an LAVH are relatively small. The scars, pain, and recovery time from LAVH are usually significantly less than with an abdominal hysterectomy, which requires both a vaginal incision and a 4-6 inch (10-15 cm) long incision in the abdomen). LAVH is similarly less physically traumatic than a routine vaginal hysterectomy. When LAVH is feasible, it has distinct advantages.
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