What is LAVH?
A Laparoscopic assisted vaginal hysterectomy is the removal of the uterus and also the cervix via a small cut in the the surface of the vagina while the upper pedicles will be dissected with the laparoscopic surgery. When this operation is facilitated by conducting a laparoscopy, the procedure is known as an LAVH. Removal of the ovaries is generally possible simultaneously if required, but some gynecologists are not in favor of removing ovary unnecessarily. There are several kinds of hysterectomy and an LAVH is usually chosen when there is a need to remove both the cervix and also the ovaries if good vaginal access is available. Not every women are suitable for a LAVH and it can be a challenge when the uterus is extremely enlarged, or have multiple myoma and for those who have had multiple caesarean sections, or not had any vaginal births.
Options to Laparoscopic assisted vaginal hysterectomy surgery (LAVH)
A Laparoscopic Assisted Vaginal hysterectomy (LAVH) is not usually performed for period problems unless other, more simple treatments happen to be tried. Alternative options of treating heavy periods include hormonal therapy, a Mirena coil and endometrial ablation. Prolapse can often, although not always, be controlled by a plastic pessary inserted into the vagina. However, a pessary is not usually suitable for ladies who wish to remain if perhaps patient is uncomfortable with that.
What should patient should do before the operation of (LAVH)?
Patient will usually come to the hospital a couple weeks before the operation and have a variety of simple pre anesthetic tests to make sure she is fit for surgery. Smoking increases the risk of complications so, if possible, please try to quit smoking per month prior to the operation. Any cardiac or other medicine if patient is taking it should must be stopped.
Patient will be admitted to World Laparoscopy Hospital at the time from the operation where she is going to be seen by gynecologist and that doctor will answer any questions or worries which patient may have. Also anaesthetist of World Laparoscopy Hospital can come and discuss with the options of the general anaesthetic where patient fall asleep, or regional anaesthesia (as an epidural). More details can be obtained in the World Laparoscopy Hospital website.
What happens during LAVH surgery?
- A ‘drip’ will be placed in patient arm or hand to give her any fluids or drugs which she may need.
- The operation takes between 30 and 100 minutes.
- A small tube will be place in patient's bladder to drain urine. This is called a catheter.
- A gauze pack may be placed within the vagina to prevent bleeding.
What happens after LAVH surgery?
Patient will be taken to the recovery room and kept there until she is fully awake and stable; then patient will be reclaimed towards the ward. Patient will be given pain relief to help keep her comfortable. Patient will find different ways of treating any pain patient may have, from injections, tablets, to suppositories. Permanently is called Patient Controlled Analgesia (PCA) and it enables patient to press a button attached to a pump containing the medicine. This pump is specially created to prevent patient giving yourself too much medication.
It is usual to feel some pain or discomfort following a major operation but the doctor's team of World Laparoscopy Hospital will try tough to minimise this pain. Assuming patient is eating and drinking normally, the drip will be removed after 24 to 48 hours of laparoscopic assisted vaginal hysterectomy. For those who have a vaginal pack insterted during LAVH surgery, it is usually be removed on the day following laparoscopic surgery. The catheter will normally be taken off your bladder next days.
How will LAVH surgery affect patient?
Patient will probably remain in World Laparoscopy Hospital for approximately 2 days, when she gradually return to normal. When she is ready for home in completely good health, she will be given a way to obtain pain alleviation and some antibiotics if required. It's quite common to feel more tired after any major operation, and it is vital that patient should keep mobile but take it easy. Patient who has undergone LAVH should avoid heavy-lifting and strenuous exercise for about 3 months and intercourse for one month. Patient should check with her insurance provider if she think able and wish to drive before 6 weeks. Time before Patient go back to work is determined by the work she does, and she can discuss this together with the doctor.
Laparoscopic Surgeon of World Laparoscopy Hospital will again see you for a check-up approximately 6-8 weeks following the LAVH operation. Patient will be advised when other normal activities could be resumed, for example sport and sexual activity. Removing her uterus shouldn't affect your libido and Patient will usually resume sexual intercourse after your check-up.
What are the Potential complications of LAVH?
Every treatment has its own benefits, but there's also possible risks that Patient should be familiar with before Patient decide to accept having a hysterectomy.
What are the potentially serious risks?
- Injury towards the bladder or bowel or ureter (the tube between the kidney and bladder).
- Excessive bleeding needing a blood transfusion.
- Back to theatre to control bleeding or repair injury. This may need a cut inside Patient abdomen.
- Serious infection within the pelvis or perhaps in the bloodstream.
- Thrombosis-a blood clot within the leg or lung.
What are the more frequent but less serious risks after LAVH?
- Passing urine more frequently.
- Minor infections eg. of chest, bladder, wound, pelvis.
- Sometime collection of blood called haematoma within the pelvis
- Persistent abdominal pain which may be related to adhesions inside the pelvis.
- Patient may find it hard to empty your bladder properly after surgery.
- A catheter might need to be placed into the bladder temporarily if this happens.
Additional procedures which may be necessary during Patient's operation Blood transfusion.
If you suffer with increased bleeding during or after Patient hysterectomy, it may be essential to provide her with a blood transfusion. About 15 women out of every 1000 having this operation will require blood transfusion. If she feel strongly from this then please talk to the patient advisor.
A laparotomy an incision inside Patient lower abdomen may also be necessary. Reasons include: to manage bleeding, the repair of an injured internal organ, or maybe it is technically difficult to remove patient's uterus with the vagina.
Patient should keep in mind that extra procedures during the course of her hysterectomy are only done if it is necessary to save her valuable life or prevent serious harm to health.