Technological advancement in medical science has given a great impetus to endoscopic surgery. Various ailments require surgery, and to make surgery less life-threatening and ensure fewer postoperative complications, endoscopy or laparoscopic surgeries are now being used by surgeons.
Laparoscopic surgery is a surgery in which a telescope, along with some other devices, is introduced into a patient’s body to view the interior parts of the body clearly on a monitor screen. In addition to advances in electrosurgical units, optics, technology, and instrumentation, the area of endoscopic surgery has been expanding with every passing day. It also enables a surgeon to keep an eye on minute changes. These laparoscopic surgeries are being used to treat various ailments such as gynecological disorders, appendectomy, cholecystectomy, hernia repair, etc.
In gynecology, surgeons prescribe LAVH mainly for uterine disorders. LAVH refers to a laparoscopic and vaginal hysterectomy for the removal of the uterus more conveniently.
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What is LAVH?
LAVH is endoscopic surgery, a combination of laparoscopy and vaginal hysterectomy. During this procedure, the uterus is surgically removed from the body using a vaginal method accompanied by laparoscopic surgery. Laparoscopy facilitates viewing and provides enough exposure for a surgeon to safely remove a uterus through the vaginal cavity.
This surgery boosts postoperative recovery, leaves a very small scar, ensures a shorter hospital stay, reduces blood loss, results in fewer complications, and helps patients quickly resume their daily activities.
What are the Indications of LAVH?
A gynecologist will make a diagnosis based on the symptoms after a thorough examination. However, there are some common indications for LAVH, including:
- ● Dysfunctional uterine bleeding: Abnormal bleeding from the uterus that does not coincide with a menstrual cycle
- ● Uterine fibroid: An abnormal growth in the uterus.
- ● Endometriosis
- ● Benign growth in the ovaries or fallopian tubes
- ● Traumatic rupture of the uterus or tear in the uterus
- ● Genital prolapse
- ● Uterine perforation
- ● Cervical tear
- ● Undescended uterus
- ● Removal of the uterus in the menopausal stage
What are the Contraindications of LAVH?
LAVH should be avoided in certain circumstances because of the possibility of high complications. These conditions are-
- ● Pregnancy of more than 16 weeks
- ● Pelvic infections
- ● Severe cardiopulmonary diseases
- ● Generalized peritonitis
- ● Intestinal obstruction
- ● Advanced cancerous stage
- ● Large pelvic tumor
- ● An individual is on anticoagulation therapy
- ● Extensive peritoneal adhesions
What is the Procedure for LAVH?
LAVH surgery usually requires around 1-2 hours.
Your doctor runs an investigation to confirm your diagnosis and then takes your consent to perform this procedure. The day before surgery, a light diet is advised. Patients are not permitted to consume anything in the morning on the day of surgery. It is recommended not to consume anything 8 hours preceding the surgery. The cleansing enema is given in the evening before surgery. Your abdomen and pelvis area will be cleaned before surgery. Also, your pubic hair will be removed. You will then be given general anesthesia after an IV line is inserted in your hand or arm.
You will lie on an operating table in lithotomy position, which means you will have your back to the table, your legs bent at a 90-degree angle at the hips and knees, and your feet resting on a pad attached to the table. Once you are in a suitable position, a small cut is made just below the umbilical area to introduce a needle in your abdomen. The abdomen is inflated with gas to make enough room for the surgeon to view the abdominal organs clearly. A laparoscope is then introduced into the body. Three or four more cuts are made in the abdominal area to insert a surgical device that will help remove the uterus. Using a laparoscope and small instruments, the blood vessels near the uterus are tied and stapled to prevent bleeding, and the supportive tissues of the uterus are detached to aid the removal of the uterus systematically. The remaining procedure of uterus removal is done vaginally. The uterus is then removed through the vagina, and after its removal, the cuts are properly stitched and dressed to avoid adhesions and prevent infections. LAVH usually takes 1-2 hours. However, a hospital stay is required post-surgery.
Similar to any other gynecological surgery, proper care is required after LAVH. Your doctor puts you on an antibiotic course, and you are allowed to begin consuming your regular diet within the next 12 hours. It is recommended to engage in physical activities after 10-12 days. It is also advised to avoid sexual intercourse for the next 6 weeks.
What are the Benefits of LAVH?
Hysterectomy can be done through the abdomen or vagina. Here are some benefits of LAVH:
- ● Rapid postoperative recovery
- ● Less operative pain
- ● Requires fewer analgesics
- ● A shorter hospital stay
- ● Fewer postoperative complications
- ● No large abdominal scar
- ● Can resume daily activities early
- ● Lower blood loss
- ● No adhesions
- ● Lower risk of incisional hernia
What are the Complications of LAVH?
Despite its positive effects, there are some complications associated with LAVH. During LAVH, there are chances of an injury to the blood vessels or bowel, surgical swelling in the affected part, blood clots in the veins, complications from anesthesia, and infection.
What are the Things to Remember After the Procedure?
After surgery, the body requires proper rest. Ensure to contact your doctor if you develop a fever, chills, severe pain, redness, pus discharge from the abdominal scar, shortness of breath, chest pain, or a problem with urination or defecation. Also, make sure to follow your doctor’s advice and visit the hospital regularly for follow-ups.
In a nutshell, LAVH is a combination of laparoscopy and vaginal hysterectomy prescribed by various gynecologists for uterus removal. Laparoscopy technology makes surgery convenient for the individual. Also, the chances of complications are reduced. It is suitable as hospital stay is also reduced and postoperative care is easy.
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What are some of the advantages of LAVH?
LAVH, a laparoscopic-assisted vaginal hysterectomy, has positive sides that make it highly recommendable. This is because the recovery time is short, the scars are small, the hospital stay is short, and there are fewer complications in this surgical procedure.
When will I be able to go home after my surgery?
LAVH requires fewer hospital days. You need to stay a minimum of 2 days, but it can vary depending on your surgeon.
Why should I opt for LAVH?
If you are suffering from an abnormal bleeding problem, adhesions in the uterus, endometriosis, or fibroids, they may be treated by LAVH.
What are the warning signs I should watch out for after surgery?
If you have a fever over 100 degrees Fahrenheit, severe pain, heavy bleeding, or you have been experiencing problems during urination, you should seek medical attention as early as possible.