Laparoscopically Assisted Vaginal Hysterectomy (LAVH)

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.)

Before the Procedure

You do not qualify for LAVH if you have advanced cancer. Your physician will also conduct a full physical exam, including blood, Pap smear, and imaging tests.
Always tell your health care provider or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
During the days before the surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your health care provider which drugs you should still take on the day of your surgery.

On the day of your surgery:

• You will very often be asked not to drink or eat anything for 6 – 12 hours before the surgery.
• Take the drugs your health care provider told you to take with a small sip of water. Your health care provider or nurse will tell you when to arrive at the hospital

FAQS

Frequently asked questions about surgical procedures

What’s not included:

• Lab testing before and after the surgery, as needed
• Electrocardiogram (EKG), depending on age. If you had one elsewhere in the past 6 months and it read “normal”, we can forego this expense.
• Imaging costs. X-rays and MRIs can be obtained anywhere.
• Physical therapy services
• Medications you’ll need (oral or IV antibiotic infusions if an infection arises)
• Wound care
• Bracing supplies
• Additional doctor visits (a pre-operative visit with the surgeon, in person, and any required post-op follow-ups after the suture removal to monitor your progress
• Additional surgical intervention if a complication arises
• Additional imaging or hospital care if a blood clot develops

Laparoscopically Assisted Vaginal Hysterectomy (LAVH)

LAVH combines laparoscopy and hysterectomy. Laparoscopy is used to look into the abdomen at the reproductive organs. Hysterectomy is a surgery to remove the uterus.
The uterus can be removed in two ways. When it is removed through a large cut (incision) in the abdomen, the procedure is called an abdominal hysterectomy (the past).
Today, LAVH involves the use of a small, telescope-like device called a laparoscope. The laparoscope is inserted into the abdomen through a small cut. It brings light into the abdomen so that your doctor can see inside. Tiny instruments are also inserted to perform the procedure. Ligaments that support the uterus are cut with these instruments, and the uterus is removed vaginally.
The benefits of LAVH include a short post-operative recovery time, which can be as little as a few hours after the surgery, to a day or two, depending on your condition. Also, many patients can return to work and normal activities within 1 to 2 weeks. Most patients appreciate that LAVH has better cosmetic results, with only tiny scars.

What to expect after your surgery

Recovery

Recovery from laparoscopic surgery is significantly faster and less painful than recovery from traditional surgery. After LAVH, you will no longer have any vaginal bleeding. There will be no hormonal changes when the ovaries are preserved. Most women say that sex is unchanged, or even improves, because of the elimination of bleeding and pain. You may experience some vaginal dryness, which can be treated with estrogen cream and lubricants. You will be taken to the recovery room and monitored for a short time before going to the observation unit.
Depending on the length of your surgery, you may not be able to eat or drink anything until the next morning, or you will be started on a liquid diet. When you are feeling better you may return to a regular diet.
You may have cramping, feel bloated, or have shoulder pain.
You may have a scratchy or sore throat from the tube used for your anesthesia.
You will:

• Be given medications for pain and nausea if needed.
• Have the tube in your bladder removed in the recovery room.
• Have compression stockings on your legs to improve circulation.
• Be restarted on your routine medications.
• You will be given a small plastic device at your bedside to help expand your lungs after surgery.
• Start walking as soon as possible after the surgery to help with healing and recovery.
• Stay in the hospital for 23 hours.

Risks

Although there can be problems that result from surgery, we work very hard to make sure it is as safe as possible. However, problems can occur, even when things go as planned. You should be aware of these possible problems, how often they happen, and what will be done to correct them.
Possible risks during surgery include:

• Bleeding
• Conversion to an open surgery requiring an up-and-down or Bikini incision.
• Damage to the bladder, ureters, and the bowel
• Blood clot in the legs or lungs
• Bowel obstruction
• Hernia
• Incision opens Infection
• Scar tissue

How are follow-up and initial consultations handled?

In-person and telehealth consultations are possible with the surgeon to whom your case is assigned. The initial visit is included in the surgical package and is valued at $375.
We can also obtain the flights from the volunteer pilot nonprofit if you’d like to come for initial and follow-up visits in person. One follow-up visit is included in the surgical package at a value of $175. Any additional visits are charged at the time of service to your credit or debit card.