LAVH
A laparoscopic-assisted hysterectomy (LAVH), a precursor to the TLH, is a technique to secure the ovarian and uterine vasculature via laparoscopy; the remainder of the procedure is completed vaginally. The laparoscope is often reinserted after closure of the vaginal cuff to inspect the abdomen and vaginal cuff for adequate haemostasis at the end of the procedure. This procedure requires adequate uterine descent to safely complete the vaginal portion of the procedure.
Its greatest benefit is the potential to convert what would have been an abdominal hysterectomy into a vaginal hysterectomy. An abdominal hysterectomy requires both a vaginal incision and a four to six-inch-long incision in the abdomen, which is associated with greater post-operative discomfort and a longer recovery period than for a vaginal procedure. Another advantage of the LAVH may be the removal of the tubes and ovaries which on occasion may not be easily removed with a vaginal hysterectomy.
This does not mean that all hysterectomies could or should be done by LAVH. There are certain conditions that will necessitate abdominal or vaginal hysterectomy.
When LAVH is performed, several small abdominal incisions are made. Through these small incisions slender metal tubes known as "trocars" are inserted. They provide passage for a laparoscope (which is like a tiny telescope) and other microsurgical tools. A camera attached to the laparoscope provides a continuous image that is magnified and projected onto a television screen. It provides the view by which the surgeon operates.
The uterus is detached from the ligaments that attach it to other pelvic structures using laparoscopic tools, electro-coagulation or a laser. Adhesions may have to be freed and, if the tubes and ovaries are to be removed, they are detached from their ligaments and blood supply. They then can be removed with the uterus through an incision made in the vagina. Since the incisions are small, the scarring and pain from LAVH is often less than that associated with abdominal hysterectomy.
This approach is best for benign conditions that lead to hysterectomy when the uterus is not too large. It is often the best approach for uterine prolapse. With a vaginal hysterectomy, you will not have any external scarring. You may also recover more quickly because you are not waiting for a large abdominal incision to heal.
However, vaginal hysterectomy gives the surgeon less room to operate and no real opportunity to view your pelvic organs.
Laparoscopically assisted vaginal hysterectomy offers an alternative. It is a combined procedure that can remove the uterus vaginally when it otherwise would require a large abdominal incision.