Name of the Procedure:

Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s). Commonly known as Laparoscopic-assisted Vaginal Hysterectomy (LAVH) with Salpingo-Oophorectomy.

Summary

LAVH with Salpingo-Oophorectomy is a minimally invasive surgical procedure to remove the uterus along with one or both fallopian tubes and/or ovaries. It involves small incisions in the abdomen and a vaginal approach to remove the uterus and associated structures.

Purpose

This procedure addresses medical conditions such as uterine fibroids, endometriosis, chronic pelvic pain, or certain types of cancer. The goal is to alleviate symptoms, remove diseased tissue, and improve the patient's quality of life.

Indications

• Persistent pelvic pain
• Heavy menstrual bleeding
• Uterine fibroids
• Endometriosis
• Ovarian cysts or tumors
• Uterine or ovarian cancer
• Adnexal masses

Preparation

• Patients are typically instructed to fast for at least 8 hours before surgery.
• Medications may need to be adjusted; specific instructions will be provided by the healthcare provider.
• Preoperative diagnostic tests might include blood work, imaging studies like ultrasound or MRI, and a pelvic examination.

Procedure Description

1. The patient is placed under general anesthesia.
2. Small incisions are made in the abdomen to insert a laparoscope (a small camera) and other surgical instruments.
3. The laparoscope provides a visual guide for the surgeon.
4. Using the laparoscopic instruments, the surgeon detaches the uterus and, if necessary, the fallopian tubes and/or ovaries.
5. The detached tissues are then removed through the vaginal canal.
6. The small incisions in the abdomen are closed with sutures or staples.

Duration

The procedure typically takes about 2 to 3 hours, depending on the complexity and extent of the surgery.

Setting

The procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Common risks include bleeding, infection, and pain.
• Rare complications might involve injury to surrounding organs (bladder, intestines), blood clots, or adverse reactions to anesthesia.
• Management includes appropriate postoperative care and, if necessary, further medical intervention.

Benefits

• Relief from symptoms like pelvic pain and heavy bleeding
• Removal of diseased or cancerous tissues
• Potentially quicker recovery time compared to open surgery
• Small abdominal scars

Recovery

• Post-procedure, patients are monitored in a recovery room for a few hours.
• Pain management includes medications prescribed by the healthcare provider.
• Most patients can return to light activities within 1-2 weeks, with complete recovery expected in about 6 weeks.
• Follow-up appointments are necessary to monitor healing and address any concerns.

Alternatives

• Medication management for symptoms
• Uterine artery embolization (for fibroids)
• Endometrial ablation (for heavy bleeding)
• Abdominal hysterectomy (open surgery)
• Pros and cons vary; alternatives might involve longer recovery times or different risk profiles.

Patient Experience

Patients will be under general anesthesia during the surgery and will not feel pain during the procedure. Postoperatively, there might be mild to moderate pain managed with prescribed medications. Discomfort from the small abdominal incisions and vaginal discharge is common. Most patients report gradual improvement in symptoms and quality of life following recovery.