Laparoscopic assisted vaginal hysterectomy is called an LAVH for short. It is done starting with a laparoscopic procedure and then a vaginal hysterectomy is done to complete the surgery. There is usually an overnight stay in the hospital with recovery being 2-4 weeks. The most common reasons for an LAVH is in a situation where a vaginal hysterectomy is to be performed but there is either the worry of scar tissue or in the case where the ovaries need to be removed as well as the uterus.
The procedure is started by placing a camera through a small incision in the belly button and then two other small incisions are made in the abdomen for more equipment. Scar tissue can then be removed or the ovaries can be removed using these small incisions. When the work with the laparoscope is complete it is removed and the patient’s legs are then elevated in stirrups. A vaginal hysterectomy is then performed. The advantage of an LAVH is the ability to perform a vaginal hysterectomy in patients that may not otherwise be safe candidates for this procedure.
There are many potential causes for scar tissue inside the pelvis. Previous surgery such as an appendix, a cyst removal, or an ectopic pregnancy can all cause scarring. Previous infection of the pelvis can also cause scar tissue to form. If the uterus has scarring to the pelvis or other pelvic structures, a vaginal hysterectomy may not be safe or even possible. An LAVH can remove the scar tissue to allow for a vaginal hysterectomy to be performed.
There are situations in which it is very important that the ovaries be removed during a hysterectomy. An ovarian cyst or a strong family history of ovarian cancer are two examples of situations in which the ovaries may need to be removed. During standard vaginal hysterectomy the ovaries are only able to be removed about 80% of the time. If it is importnt that the ovaries be removed an LAVH may be a good option. This allows a vaginal hysterectomy to be performed but still guarantees removal of the ovaries.
An LAVH combines elements of both a vaginal hysterectomy with a laparoscopic hysterectomy. In the appropriate patient this can serve to minimize recovery while still being able to remove the cervix, uterus, and when appropriate the ovaries.