In simple words, we go through your belly button with a scope or camera that allows us to see your internal organs. Then we insert 2-3 more small instruments with tools at their tips. These tools are used to do what we would have otherwise done through open surgery. Now, depending on how the uterus comes out and how we close the vagina back, you will have 2 more names for this procedure.
Either Total Laparoscopic Hysterectomy (TLH) where all the procedure is done through the scope. Or Laparoscopic Assisted Vaginal Hysterectomy (LAVH) where the vaginal opening is closed vaginally, not through the scope.
And what is the difference between these two types of surgery? To you, nothing. In both, you get no scar on your tummy, early discharge, early recovery, etc. The difference is based on many variables, including tools available in your hospital, surgeon training, surgeon preference, etc.
Can everyone who needs a hysterectomy get it through a scope?
Well, we never say never and we never say always. While we believe it should be offered to nearly every woman, there are clearly many reasons why this might not be the best option for you. Reasons might include a very large uterus, large or suspicious ovaries, too many previous abdominal surgeries (including C Sections). Also, on the list is known previous scaring, severe endometriosis, or in some cases, not having had vaginal deliveries.
Good reasons that might not pertain to you would include the hospital (city/country) where you are, the presence of equipment and/or your gynecologist preference.
Suggestion: do not push your doctor out of their comfort zone.
How long do I stay in the hospital?
You can go home the same day. The procedure is very similar to removing an ovarian cyst by the scope, or may be like tying your tubes. If you have good support at home, you can go home after 6-8 hours. Some hospitals will keep you overnight.
If the surgery is associated with some other procedure, or if you end up with open surgery, you might stay longer.
Is there pain after LAVH.
With any type of surgery there is some pain. It is more like the pain after tying your tubes, or may be having a scope for endometriosis. You may have more abdominal bloating and cramping. The pain usually lasts a few days. It does not at all compare to pain after open surgery.
When can I move around?
We usually book a follow up visit in a week. At that time, you are walking normal, and no one can even believe you had your uterus removed one week ago.
When can I drive?
If all went well, and you are not in pain, you can drive as soon as you feel you are normal. Most patients are able to drive with no problems in 7-10 days. Please make sure you contact your physician before you do actually drive to make sure it is safe to do so. Do not drive if you are taking pain medications, or have severe pains, active bleeding, fever, or if you are unwell in general.
When can I be active again?
Good question. After surgery we encourage you to walk around and move out of bed as early as possible. This includes the day of surgery and the days after that. When at home say the first week or two, take it easy. There is no real reason why you need to move that sofa around. Nor will the house collapse if you do not vacuum for a week. After that, gradually start adding in more work and activity.
I like to warn you that you will actually feel too well for someone who had surgery done. So, do take it easy.
You may feel tired
And the reason for that is the way our bodies react to trauma. The hormones of stress will make you feel tired, lose weight and take some time before you are yourself again. This is a natural response. If you feel too weak, or unwell, visit your doctor.
When can I go back to work
Within a few weeks. This will depend on your type of work, and how well you feel. Most women are able to go back to work in 2-3 weeks.
When can I be sexually active again?
Again, as started before, you will feel to well for the type of surgery you had. But do remember that, while you have no scar on your abdomen, you do have a scar on your vagina (the tip of the vagina were the cervix was, was opened, the cervix removed and there are stitches up there). Nothing goes up the vagina for 6 weeks.
About having LAVH
You will have a discussion about the condition and discuss the possible management options. Do discuss possible non surgical as well as surgical options. If you choose surgery, then
Do discuss possible routes, including Abdominal Hysterectomy, vaginal hysterectomy and possible laparoscopic assisted hysterectomy.
Do also discuss the option of keeping the ovaries as well as taking them out,
Do discuss the option of taking the tubes out.
Ask about the cervix.
Complications, things you need to know:
The possible side effects and complications, include
Complications of anaesthesia, depending on type used:
-Teeth complications, chipped tooth, crowns falling
-Soar throat after surgery, rarely injury
-Lung complications, collapsed lung (rare), aspiration (rare)
-The anesthetist will talk to you in more details about possible complications. If you have know issues with anaesthesia, or have a family history of, say, Malignant Hyperthermia, make sure they know before they put you to sleep.
Complications of the surgery itself
Bleeding and possible blood transfusion
Infections and antibiotic prophylaxis
Injury of internal organs: ureter, bladder, intestines, colon, blood vessels,
Possible clots in the legs or lungs DVT/PE and heparin prophylaxis, and possible hematomas and bleeding. We recommend at least TED Stocking, below knee before surgery.
You will not be able to get pregnant again
Rarely there is the chance of not being able to continue the procedure as planned, example: ending up with open surgery when we started with vaginal hysterectomy or laparoscopic hysterectomy
There will be scars on the abdomen (hopefully small), pain after surgery, etc.
Also think about changes (and lack thereof) of body function, effect on sexuality (usually none), body image, as well as recovery,
Most women who have LAVH will need about 2 weeks of work. This is compared to 6 weeks of work if you end up with open suregry.
You will need to wait for 6 weeks with no sexual activity.
Make sure you have been given time to ask questions and decide, and that you sign the consent for surgery.