What is Laparoscopically Assisted Vaginal Hysterectomy (LAVH)

Laparoscopically assisted vaginal hysterectomy is a surgical procedure to remove the uterus and cervix. Sometimes, the ovaries and fallopian tubes are also removed. This surgery may be done to treat problems such as:

• Noncancerous growths in the uterus (uterine fibroids) that cause symptoms.
• A condition that causes the lining of the uterus to grow in other areas (endometriosis).
• Problems with pelvic support.
• Cancer of the cervix, ovaries, uterus, or tissue that lines the uterus (endometrium).
• Excessive (dysfunctional) uterine bleeding.

During an LAVH, some of the surgical removal is done through the vagina, and the rest is done through a few small incisions in the abdomen. This technique may be an option for women who are not able to have a vaginal hysterectomy.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Difficulty breathing.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• You may be asked to take a medicine to empty your colon (bowel preparation).
• You may be given antibiotic medicine to help prevent infection.

General instructions

• Plan to have someone take you home from the hospital or clinic.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be asked to shower with a germ-killing soap.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay healing after surgery. If you need help quitting, ask your health care provider.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your skin will be washed with soap.
• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• You may have a flexible tube (catheter) put into your bladder to drain urine.
• You may have a tube put through your nose or mouth down into your stomach (nasogastric tube). The nasogastric tube will remove digestive fluids and prevent nausea and vomiting.
• Tight-fitting (compression) stockings will be placed on your legs to promote circulation.
• Three or four small incisions will be made in your abdomen. An incision will also be made in your vagina.
• Probes and tools will be inserted into the small incisions. The uterus and cervix (and possibly the ovaries and fallopian tubes) will be removed through your vagina as well as through the small incisions that were made in the abdomen.
• The incisions will then be closed with stitches (sutures).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may have a liquid diet at first. You will most likely return to your usual diet the day after surgery.
• You will still have the urinary catheter in place. It will likely be removed the day after surgery.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
• You will be encouraged to walk as soon as possible. You will also use a device or do breathing exercises to keep your lungs clear.
• Do not drive for 24 hours if you were given a sedative.

Summary

• A laparoscopically assisted vaginal hysterectomy (LAVH) is a surgical procedure to remove the uterus and cervix, and sometimes the ovaries and fallopian tubes.
• Follow instructions from your health care provider about eating and drinking before the procedure.
• During an LAVH, some of the surgical removal is done through the vagina, and the rest is done through a few small incisions in the abdomen.

Laparoscopically Assisted Vaginal Hysterectomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Soreness and numbness in your incision areas.
• Abdominal pain. You will be given pain medicine to control it.
• Vaginal bleeding and discharge. You will need to use a sanitary napkin after this procedure.
• Sore throat from the breathing tube that was inserted during surgery.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not take aspirin or ibuprofen. These medicines can cause bleeding.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• Do not drive for 24 hours if you were given a medicine to help you relax (sedative) during the procedure.

Incision care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Activity

• Get regular exercise as told by your health care provider. You may be told to take short walks every day and go farther each time.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not douche, use tampons, or have sexual intercourse for at least 6 weeks, or until your health care provider gives you permission.
• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that your health care provider tells you, until he or she says that it is safe.

General instructions

• Do not take baths, swim, or use a hot tub until your health care provider approves. Take showers instead of baths.
• Do not drive for 24 hours if you received a sedative.
• Do not drive or operate heavy machinery while taking prescription pain medicine.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have signs of infection, such as:
  • Redness, swelling, or pain around your incision sites.
  • Fluid or blood coming from an incision.
  • An incision that feels warm to the touch.
  • Pus or a bad smell coming from an incision.
• Your incision breaks open.
• Your pain medicine is not helping.
• You feel dizzy or light-headed.
• You have pain or bleeding when you urinate.
• You have persistent nausea and vomiting.
• You have blood, pus, or a bad-smelling discharge from your vagina.

Get help right away if:

• You have a fever.
• You have severe abdominal pain.
• You have chest pain.
• You have shortness of breath.
• You faint.
• You have pain, swelling, or redness in your leg.
• You have heavy bleeding from your vagina.

Summary

• After the procedure, it is common to have abdominal pain and vaginal bleeding.
• You should not drive or lift heavy objects until your health care provider says that it is safe.
• Contact your health care provider if you have any symptoms of infection, excessive vaginal bleeding, nausea, vomiting, or shortness of breath.