Name of the Procedure:

Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)

• Common Name: Laparoscopic-Assisted Vaginal Hysterectomy (LAVH)
• Medical Term: Laparoscopic-Assisted Vaginal Hysterectomy with Bilateral Salpingo-Oophorectomy (LAVH with BSO)

Summary

Laparoscopic-Assisted Vaginal Hysterectomy (LAVH) is a minimally invasive surgical procedure where the uterus, and sometimes one or both fallopian tubes and ovaries, are removed through the vagina with the aid of a laparoscope. The laparoscope is a thin, lighted tube with a camera that allows the surgeon to see inside the abdomen and guide the removal.

Purpose

LAVH with BSO addresses several medical problems, such as:

• Uterine fibroids
• Endometriosis
• Uterine prolapse
• Chronic pelvic pain
• Heavy menstrual bleeding
• Gynecologic cancers The goal of the procedure is to remove the uterus (and sometimes tubes and ovaries) to alleviate symptoms, treat disease, or prevent cancer.

Indications

• Persistent heavy menstrual bleeding not responsive to other treatments.
• Large fibroids causing pain or pressure.
• Endometriosis not responsive to medical treatment.
• Presence of uterine or ovarian cancer.
• Uterine prolapse.
• Chronic pelvic pain unresponsive to other treatments.
• Patient is medically cleared and desires surgery after discussion of other options.

Preparation

• Patients are usually advised to fast for 8-12 hours before the procedure.
• Blood tests, imaging studies, and a preoperative physical exam are often required.
• Medication adjustments may be needed, for example, stopping blood thinners.
• A bowel prep might be necessary to clear the intestines.

Procedure Description

1. Under general anesthesia, small incisions are made in the abdomen to insert the laparoscope and surgical instruments.
2. Carbon dioxide gas may be pumped into the abdomen to expand it for better visibility.
3. The surgeon uses the laparoscope to cut and detach the uterus, fallopian tubes, and/or ovaries.
4. The uterus and other organs are removed through the vagina.
5. Incisions are closed with sutures or surgical glue.
6. The patient is then taken to the recovery room to wake up from anesthesia.
   • Tools/Equipment: Laparoscope, surgical instruments, carbon dioxide gas.
   • Anesthesia: General anesthesia.

Duration

The procedure typically takes between 2 to 4 hours.

Setting

The procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Lead Surgeon (Gynecologist)
• Surgical Assistant(s)
• Anesthesiologist
• Operating Room Nurse(s)
• Surgical Technologist

Risks and Complications

• Common Risks: Infection, bleeding, blood clots, reaction to anesthesia.
• Rare Complications: Damage to surrounding organs (bladder, intestines), hernias at incision sites, long-term pelvic pain, adhesions.

Benefits

• Relief from chronic pain, heavy bleeding, or pressure symptoms.
• Treatment and potential cure of endometriosis, fibroids, or cancer.
• Shorter recovery time compared to traditional open surgery.
• Reduced pain and shorter hospital stay.

Recovery

• Post-procedure care includes pain management with medications, avoiding heavy lifting, and keeping incisions clean.
• Most patients can go home the next day but may experience some pain and fatigue.
• Full recovery typically takes 4 to 6 weeks.
• Follow-up appointments are necessary to monitor healing.

Alternatives

• Medication management (e.g., hormonal treatments).
• Endometrial ablation (for heavy bleeding).
• Myomectomy (removal of fibroids only).
• Watchful waiting (in cases where immediate surgery is not critical).
• Pros: Less invasive, less immediate recovery time.
• Cons: May not fully address the condition, symptoms may persist or worsen.

Patient Experience

• During the procedure, the patient will be under general anesthesia and will not feel pain.
• Postoperatively, patients may experience discomfort, bloating, and pain at incision sites.
• Pain management includes prescribed pain relievers and rest.
• Patients should have support at home for the initial recovery to assist with daily tasks.