A vaginal hysterectomy is a way to take out the uterus through the vagina. The uterus is a muscular organ at the top of the vagina where menstruation begins and babies grow. In a vaginal hysterectomy assisted with laparoscopy, the doctor uses a tool called a laparoscope to help with the removal.

Why should I have a hysterectomy?

There are many reasons why you and your doctor may decide to take out your uterus. Some of the problems that can be fixed by a hysterectomy are:

Tumors in your uterus.
Steady bleeding from your uterus.
Endometriosis
Chronic pelvic pain.
Precancerous or cancerous lesions on the cervix
A fallen (sagging) uterus--if your vaginal walls are also dropping or sagging, your doctor may repair them during the hysterectomy procedure.

Examples of alternatives to a vaginal hysterectomy are:

Having your uterus removed through a cut in your abdomen (abdominal hysterectomy)
Taking medications to control the problem
Choosing not to have treatment.

You should ask your doctor about these choices.

How should I prepare for this procedure?

Plan for your care and recovery after the operation, especially if you are to have general anesthesia. Allow for time to rest and try to find other people to help you with your day-to-day duties.

Follow instructions provided by your doctor. No special preparation is needed for regional anesthesia. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

Your doctor may give you a laxative to take the night before the surgery or an enema the morning before the surgery.

What happens during the laparoscopic procedure?

You will be given a regional or general anesthetic. A regional anesthetic numbs the lower part of your body while you remain awake. It should keep you from feeling pain during the operation. A general anesthetic relaxes your muscles, makes you feel as if you are in a deep sleep, and prevents you from feeling pain during the surgery.

An IV will be put in your arm to give you fluids and medications.
Your peritoneal cavity will be inflated with carbon dioxide gas. This will expand your peritoneal cavity like a balloon and help the doctor see your organs. The doctor makes a very small cut (puncture) in your abdomen and inserts a long narrow tube called a laparoscope. The doctor looks through the laparoscope and finds your uterus.
Through two other small cuts in your abdomen, the doctor inserts a laser or electrocautery tool to cut the tissues and blood vessels that surround and support your uterus. A laser uses light to cut tissue and stop bleeding. Electrocautery uses electricity to cut tissue and stop bleeding. The doctor then seals the blood vessels so they will heal and not bleed, removes the scope and other tools, and closes the cuts.

Next, the doctor makes a cut through your vagina and separates your uterus from your vagina by cutting it off at the top of your vagina. The doctor then removes your uterus through your vagina.

If necessary, the doctor may then repair the walls of the vagina by sewing together the ligaments around the vagina that may have stretched due to age or childbearing. These ligaments are the ones near the bladder and rectum. The doctor will then attach the vagina to these repaired ligaments. The top of the vagina is repaired so that a hole is not left.
Usually a catheter is inserted to drain your bladder during the night.

What happens after the laparoscopic procedure?

The IV and catheter are removed 1 or 2 days after the surgery. You may stay in the hospital 1 to 3 days. If your doctor repaired the walls of your vagina, you may be there for a few extra days until your bladder starts working well again. After this operation you cannot become pregnant. If you have concerns about this, discuss it with your doctor. You should ask your doctor how active you can be after this procedure and when you should come back for a checkup.

What are the benefits of this procedure?

You will no longer have the problems of tumors, bleeding, or sagging of the uterus. Also, because there will be no abdominal cut (only small punctures from the laparoscope), you will have less pain after this operation than you would if your uterus were removed through your abdomen. You will also be able to leave the hospital sooner.

What are the risks associated with the laparoscopic procedure?

There are some risks when you have general anesthesia. Discuss these risks with your doctor.
A regional anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. However, regional anesthesia is considered safer than general anesthesia.
The cut in your vagina may get infected.
If your blood vessels leak or are injured, your doctor may open your stitches to stop the bleeding.
Your bladder or rectum may be injured and need repair.
The tubes leading from your kidneys to your bladder (ureters) could be injured or tied off and may need repair.
If your doctor has trouble removing your uterus through your vagina, he or she may remove the uterus through an abdominal cut instead.
You may have some nausea.
Sometimes the carbon dioxide gas that is used to inflate your peritoneal cavity will result in pain in your right shoulder.

Your doctor may give you some drugs to help with these problems. You should ask your doctor how these risks apply to you.

When should I call the doctor?

Call your doctor immediately if:

You develop a fever.
You have pain when you urinate.
You become dizzy and faint.
You experience nausea and vomiting.
You become short of breath.
You have heavy bleeding from the vagina.

Call you doctor during office hours if:

You have questions about the procedure or its result.
You want to make another appointment.

Robert B. McWilliams, MD Reproductive Endocrinology and Gynecology

Laparoscopic Assisted Vaginal Hysterectomy (LAVH)

What is a vaginal hysterectomy assisted with laparoscopy?

What happens during the laparoscopic procedure?

What are the risks associated with the laparoscopic procedure?

Robert B. McWilliams, MD
Reproductive Endocrinology
and Gynecology