Name of the Procedure:

Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less
Common Names: Laparoscopic Vaginal Hysterectomy, Minimally Invasive Hysterectomy

Summary

A laparoscopy-assisted vaginal hysterectomy for a uterus weighing 250 grams or less is a minimally invasive surgical procedure that involves removing the uterus through the vagina with the aid of a laparoscope, a tiny camera that allows the surgeon to see inside the abdomen.

Purpose

This procedure is performed to treat various medical conditions such as uterine fibroids, endometriosis, chronic pelvic pain, abnormal uterine bleeding, and certain cancers. The goal is to alleviate the symptoms associated with these conditions and improve the patient’s quality of life.

Indications

• Uterine fibroids causing pain or bleeding.
• Endometriosis not responsive to medical treatment.
• Chronic pelvic pain suspected to be due to uterine pathology.
• Heavy menstrual bleeding not controlled by other treatments.
• Early-stage uterine or cervical cancer.
• Uterine prolapse.

Preparation

• Patients may be instructed to fast for 8-12 hours prior to surgery.
• Adjustments to medications, such as stopping blood thinners.
• Preoperative diagnostics may include blood tests, pelvic ultrasound, and ECG.
• Bowel preparation may be required in some cases.

Procedure Description

1. The patient is placed under general anesthesia.
2. A small incision is made near the navel, and the laparoscope is inserted.
3. Additional small incisions are made for surgical instruments.
4. The uterus is detached from surrounding structures using laparoscopic tools.
5. The uterus is then removed through the vagina.
6. The vaginal cuff and abdominal incisions are closed.
7. The laparoscope and instruments are removed.

Duration

The procedure typically takes about 1.5 to 3 hours, depending on individual circumstances.

Setting

This surgery is usually performed in a hospital or a specialized surgical center.

Personnel

• Lead Surgeon (Gynecologist)
• Assistant Surgeon
• Anesthesiologist
• Surgical Nurses
• Scrub Technician

Risks and Complications

• Common: Infection, bleeding, pain, and reaction to anesthesia.
• Rare: Injury to surrounding organs (bladder, intestines), blood clots, urinary retention, and complications requiring further surgery.

Benefits

• Relief from symptoms like pain, heavy bleeding, and pelvic pressure.
• Minimally invasive nature results in less postoperative pain and quicker recovery.
• Shorter hospital stay compared to open surgery.

Recovery

• Hospital stay is usually 1-2 days.
• Postoperative pain management with prescribed medications.
• Restrictions: Avoid heavy lifting and strenuous activities for 4-6 weeks.
• Follow-up appointment typically scheduled within 2 weeks post-surgery.

Alternatives

• Non-surgical treatments such as medication (hormone therapy) or uterine artery embolization.
• Other surgical options like abdominal or robotic hysterectomy.
• Pros of laparoscopy-assisted vaginal hysterectomy include less pain and quicker recovery compared to open surgery.
• Cons may include being unsuitable for very large uteri or extensive pelvic disease.

Patient Experience

• Patients can expect to feel groggy and sore immediately after the procedure.
• Pain is typically managed with medications, and most find the pain to be manageable.
• Full recovery varies, but many return to normal activities within 4-6 weeks.
• Emotional support and education on postoperative care are an essential part of the recovery process.