Laparoscopic Assisted Vaginal Hysterectomy

What is total laparoscopic hysterectomy?

Total laparoscopic hysterectomy is a surgical procedure for the removal of the uterus. In this technique, the uterus is separated from inside of the body and is removed in small pieces through small incisions or through the vagina. A hysterectomy is a major surgical procedure and has both psychological and physical consequences.

Why is it performed?

Total laparoscopic hysterectomy is done to treat conditions such as painful or heavy menstrual periods, pelvic pain, fibroids or may be performed as a part of cancer treatment. You should clearly understand the reason for this surgery.

Are there other alternatives to this treatment?

There are other conservative interventions which may be appropriate for your particular condition. Hysterectomy may be performed vaginally, abdominally, or robotically. Laparoscopic hysterectomy has benefits such as shorter recovery period, reduced post-operative pain, but it may be associated with a greater risk of complications, particularly urinary tract injury.

How is a laparoscopic hysterectomy performed?

The procedure is done under general anesthesia in the operating room. A small incision is made just below your umbilicus. The abdomen is inflated with gas and a fiber-optic instrument called laparoscope is inserted to view the internal organs. Further, small incisions may be made on your abdomen through which tiny surgical instruments are passed. Then, the uterus, cervix, and fallopian tubes are removed with or without the ovaries depending on your condition and plan with your surgeon.

What precautions should be taken before the procedure?

You can continue taking your regular medications, unless your doctor advises otherwise. You may need to have a bowel preparation which will empty your bowel before the surgery. For this, you should be on a liquid diet (soups, jellies, juices or similar drinks) for 24 hours before the surgery. Avoid smoking and if you develop signs of illness prior to your surgery, please contact you doctor immediately.

What can be expected during the recovery period?

You will be in the recovery room when you wake up from anesthesia. You may feel sleepy for the next few hours. You may have pain in the shoulder or back which is because of the gas used in the procedure. It resolves within a day or two. You may have some discomfort or feel tired for a few days after the procedure. Contact your doctor if pain and nausea does not go away or is becoming worse. You should avoid strenuous activities or exercise until you recover completely.

You may have some vaginal discharge for several days after the procedure. You should discuss with your surgeon when it ok to resume exercise, sex, and other normal activities. After the procedure, you will no longer be menstruating or be able to conceive.

You may experience bladder and bowel dysfunction and an increased risk of urogenital prolapse.

What are the possible risks and complications of this procedure?

As with any surgical procedure, there are associated risks and complications which include:

  1. Conversion to abdominal surgery
  2. Problems due to the anesthesia
  3. Injury to the internal organs
  4. Bleeding and infection

Any specific risks and complications will be discussed prior to the procedure.

What if I come across any problem during the recovery period?

You should seek immediate medical attention if you experience any of these conditions:

  • Fever
  • Offensive vaginal discharge or heavy bleeding
  • Severe nausea or vomiting
  • Inability to empty your bladder or bowels
  • Severe pain
  • ACOG
  • AIUM
  • American Association of Gynecologic Laparoscopists
  • NYU langone Medical center
  • American Association for Accreditation of Ambulatory Surgery Facilities
  • UpToDate