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Gynaecology - Hysterectomy - LAVH

Home Gynaecology – Hysterectomy – LAVH

Introduction

Hysterectomy is one of the most common gynaecological procedures conducted to remove the uterus (womb) surgically. At times, the complications in the reproductive system compel women to opt for this surgical procedure.

Gynaecologists may surgically remove only the uterus or other parts such as the cervix, fallopian tubes, or ovaries. Once a woman undergoes a hysterectomy, she cannot menstruate or conceive a child. If the ovaries are still present, they will continue producing reproductive hormones that may cause the onset of Premenstrual Symptoms (PMS), such as sensitive breasts, bloating, mood swings, and fatigue.

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Why hysterectomy?

A Hysterectomy is recommended for women with the following health conditions:

  • ● Uterine fibroids
  • ● Endometriosis
  • ● Abnormal uterine or vaginal bleeding
  • ● Uterine prolapse
  • ● Adenomyosis
  • ● Chronic pelvic pain arising due to complications in the reproductive system
  • ● Presence of cancerous tissues.

What are the Types Of Hysterectomy?

Hysterectomy involves different operative procedures based on the type of organ removal of the reproductive system. These include:

  • Total hysterectomy: The procedure involves the removal of both the cervix and uterus.
  • Subtotal hysterectomy or Supracervical hysterectomy: The procedure involves the removal of the uterus without the cervix.
  • Radical hysterectomy: If a woman shows any signs of cancer in the reproductive organs – the cervix, the uterus, fallopian tubes, or ovaries – doctors suggest the surgical removal of the affected parts.
  • Oophorectomy: The procedure involves removing ovaries, along with the uterus and fallopian tubes, if ovarian cancer has vastly spread within.
  • Prophylactic Bilateral Salpingectomy Salpingectomy: involves surgical removal of fallopian tubes to avoid the spreading of ovarian cancer.

What are the Types of Operative Procedures?

Hysterectomy procedures are done distinctly depending upon the severity of the complications in women. The abdominal or the vaginal regions are the primary routes for surgical procedures.

  • Abdominal hysterectomy: This refers to the conventional and invasive procedure that involves a horizontal cut in the lower abdominal region that surgically removes the uterus or other cancerous and fibroid tissues.
  • Vaginal hysterectomy: A less invasive and feasible traditional surgery involves a cut in the upper part of the vagina ensures womb separation from other parts of the body, followed by its removal.
  • Laparoscopic Hysterectomy: This is a surgical procedure that involves the insertion of a laparoscope with a tiny camera into the navel region or other parts of the abdomen. The surgery monitored via the camera on the display screen assists in removing the uterus or other reproductive organs through real-time videography and imaging.
  • Laparoscopic Assisted Vaginal Hysterectomy (LAVH): LAVH combines the operative procedure of vaginal and laparoscopic hysterectomy. The laparoscope insertion takes place via the vagina.

The Laparoscopic, Vaginal, and Laparoscopic-Assisted Vaginal Hysterectomy are Minimal Invasive Procedures (MIP). These require smaller body incisions and assure faster recovery with minimal pain. The preferred alternative in recent years is the LAVH procedure as it results in less blood loss and risks of infection compared to the invasive open-abdominal hysterectomy. However, each doctor recommends a specific type of surgery based on the health history and the severity of the complications depending upon each individual.

What are the Risks involved in LAVH?

The profound question related to hysterectomy is, “Are there major risks involved?” Though Modern Science and Technology has made it possible to explore various surgical procedures, even the MIPs – include LAVH – involve certain risks and complications such as:

  • ● Chronic Pain
  • ● Heavy uterine or vaginal bleeding
  • ● Vaginal Prolapse
  • ● Blood clot formation
  • ● Infection
  • ● Hematoma or accumulation of blood outside the blood vessels
  • ● Gastrointestinal (GI) tract or nerve injury
  • ● Urinary muscle spasms
  • ● Reaction to anaesthetic treatment
  • ● A variant operative procedure performance is likely to occur if severe complications arise during the surgery.

What do you do Before Proceeding with the Hysterectomy?

  • ● Gather as much information you can about your health condition and diagnosis.
  • ● Question your doctor and clear your doubts regarding the risks and operational procedure.
  • ● Discuss the surgical procedures along with the anaesthesia, whether general or local anaesthesia is mandatory.
  • ● Inform your doctor about other underlying health issues (if any) or medications that you consume. If your doctor prescribes any medicines before hysterectomy, be sure to follow those instructions strictly.
  • ● Enquire about the necessary diet plans, with the medication.
  • ● Discuss postsurgical care in detail.

What are the procedure Associated with Procedure?

The duration of a hysterectomy depends on the type of operative procedure. MIPS such as LAVH takes 1-2 hours, approximately, if there aren’t any complications during the surgery.

Here is a look at the process:

  • ● The patient lies on their back on the operative table while being injected with general or local anaesthesia.
  • ● A catheter is inserted to drain the urine from the bladder.
  • ● The sterile solution cleans the surgical areas before beginning the procedure.
  • ● A laparoscope is inserted via the vagina to reach the uterus.
  • ● The uterine blood vessels are carefully clamped via the instruments in the abdomen incisions and separated to remove the uterus, detaching it from the fallopian tubes, ovaries, and cervix.
  • ● The organ removal occurs through the vaginal opening, followed by the removal of surgical instruments, suturing, and irrigation.
  • ● The doctor also examines the patient for hematoma, haemorrhages, and clots to ensure that there are no postoperative complications.

Cancerous tissues/organs may require a different operative procedure than LAVH, based on the severity.

What do you do After a Hysterectomy?

Since LAVH is an MIP, a patient is permitted to go home on the same day after a few hours of strict observation. Some patients may stay at the hospital for a day or two.

  • ● If the vaginal bleeding persists for more than four weeks, it is best to consult the doctor immediately.
  • ● Avoid inserting tampons or menstrual cups; use sanitary pads.
  • ● The recovery period may take approximately a month based on their general health conditions and age.
  • Seek medical attention if the abdominal region frequently hurts.
  • Avoid physical stress such as intense workouts, lifting heavy weights, and sex until fully recovered for up to 6-8 weeks.

The timely diagnosis and treatment can help figure the specific surgical procedure for a patient depending on their body and general health status. Thorough scrutinisation of the complications involved in LAVH and other operative procedures minimises the risk factors using futuristic medical technologies that will render the complex operative procedure more achievable.

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