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.
Last Editorial Review: 4/24/2002
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