LAVH: Expectations and Complications
Frederick R. Jelovsek MD
Many women come to the doctor and say they want a "laser" hysterectomy. What they usually mean is a laparoscopically assisted vaginal hysterectomy or LAVH. The technique used to use lasers but now lasers have been mostly replaced by surgical clips, cautery or suturing. It's really a technique made to replace abdominal hysterectomy. If a vaginal hysterectomy can be performed in the first place, there would be no point in adding the costs and complications of laparoscopy.
More About LAVH
I'm not sure what the impression is among women of why a LAVH is desireable. I think many women believe it is safer than an abdominal or even a plain vaginal hysterectomy. Most of the medical literature supports that it has the same complications as an abdominal or vaginal hysterectomy and IN ADDITION it has the complications of laparoscopy. These include injury to major blood vessels, the bowel or the urinary tract by the laparoscope introducer (trocar) or the needle used to infuse carbon dioxide into the abdominal cavity to facilitate visualization of the pelvic structures. Another conception is that the LAVH is faster to recover from. That part is actually true when it is compared to an abdominal hysterecto
my. Without a large abdominal incision, there is less pain and recovery to normal activity is faster.
In a recent article, Kovac SR:Guidelines to determine the role of laparoscopically assisted vaginal hysterectomy.Am J Obstet Gynecol 1998;178:1257-63, the scientific data for the various types of hysterectomy was analyzed and summarized.
Comparison of Hysterectomy Types
|Abdominal hysterectomy vs. LAVH|
|Operating time||LAVH greater than abdominal hysterectomy|
|Anesthesia time||LAVH greater than abdominal hysterectomy|
|Length of hospital stay||LAVH less than abdominal hysterectomy|
|Hospital charges||No difference|
|Vaginal vs. LAVH|
|Operating time||LAVH greater than vaginal hysterectomy|
|Anesthesia time||LAVH greater than vaginal hysterectomy|
|Length of hospital stay||No difference|
|Hospital Charges||LAVH greater than vaginal hysterectomy|
Quality of life issues have also been studied and women undergoing LAVH return to normal activity sooner, although at 4 weeks postoperative there is no difference. Right now about 2 out of 3 hysterectomies are performed abdominally. Experts suggest that up to 80% of hysterectomies could be done vaginally or LAVH.