Laparoscopically Assisted Vaginal Hysterectomy
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
What is a hysterectomy?
A hysterectomy is the removal of the uterus (womb). For certain conditions, the Fallopian tubes and ovaries are also removed.
The most common medical reasons for doing a hysterectomy include benign fibroid tumors of the uterus, abnormal uterine bleeding, endometriosis, genital prolapse, and chronic pelvic pain. 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 laparoscope 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 or other small incisions 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 (LAVH)?
Laparoscopically assisted vaginal hysterectomy (LAVH) is a surgical procedure using a laparoscope to guide the removal of the uterus and/or Fallopian tubes and ovaries through the vagina (birth canal). (A different procedure, called a laparoscopic hysterectomy, is entirely performed using a laparoscope and other instruments inserted through tiny abdominal incisions, and the uterus, Fallopian tubes etc. are removed in tiny portions.)
Not all hysterectomies can or should be done by LAVH. In certain situations, a laparoscopic hysterectomy (see above) may be sufficient. In other cases, an abdominal hysterectomy or a vaginal hysterectomy (without laparoscopy) is indicated. The surgeon determines the appropriate procedure for each individual case based upon the reason for the hysterectomy and the medical history and condition of the patient.
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.It can allow for a vaginal hysterectomy in patients who have not had children.
Medically reviewed by Steven Nelson, MD; Board Certified Obstetrics and Gynecology
UpToDate.com. Laparoscopic approach to hysterectomy.
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