WOMENS-HEALTH Messages for December, 2000: Re: LAVH/ LSH

Re: LAVH/ LSH

From: D. Ashley Hill, MD (anonymous@obgyn.net)
Fri, 1 Dec 2000 22:34:37 -0600 (CST)

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At Fri, 1 Dec 2000, Tina wrote:

>I personally want to leave my cervix in tact because of the support it
>gives to the bladder and the vaginal walls. It aids in not having
>pelvic prolapse or urinary stress incontinence later on. I am just
>wondering what the operating time differences are. From the research I
>have the recovery time is quicker than that of the other methods, less
>blood loss, little or no pain medication needed, shorter hospital stay,
>etc.

I performed 4 different surgeries today, so your question is timely: Laparoscopic assisted vaginal hysterectomy (LAVH), laparoscopic subtotal hysterectomy (LSH), laparoscopic Burch bladder suspension, and an abdominal hysterectomy. Here is a *brief* summary of the differences between an LAVH and LSH, with the caveat that every patient is different, and recovery times differ widely from patient to patient.

LAVH: Part of procedure is done through the laparoscope, the rest through the vagina. Cervix is removed. In my experience, recovery is not significantly different between LAVH and LSH. Benefits: other vaginal work can be performed at the same time, much less chance of cervical cancer, generally shorter operating time required. Drawbacks: increased risk of vaginal cuff infection compared to LSH. About 70% of my LAVH patients go home the same night of surgery. If other work is done (tacking bladder, etc) then most stay overnight.

LSH: Entire procedure done through laparoscope, via a morcellator, which cuts the uterus into small pieces that can be brought out through a small skin incision. Benefits: alleged benefit of preserved pelvic support and sexual function (although, in my opinion, the medical literature on this is very sketchy. I have actually seen a couple of cases of cervical prolapse years after a subtotal hysterectomy). Potentially decreased blood loss compared to LAVH, although blood loss is usually small for either procedure. Less chance of infection. Drawbacks: usually longer operating time, and, if anatomy is unusual, if surgeon is not experienced or does not have "good hands," or just because the procedure involves burning or tying the uterine artery next to the ureter, there is an increased risk of damage to kidney tubes, bladder, intestines, etc. Further, sometimes when the cervix is left in there is daily, or at least irregular, spotting. Some women report bleeding during or after intercourse. Women who have an LSH need regular Pap screening. I would guess that about 70% of LSH patients go home the night of surgery.

I have seen no significant differences in recovery time between LSH and LAVH, unless a lot of extra work is done during the LAVH. A number of women go back to work within a week. However, some take a month, or even six weeks, to recover. Everybody is different. Good luck with your decision.

-- D. Ashley Hill, MD Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, Florida

The above is general medical information, and should not be construed as specific treatment advice. Due to time constraints, I am unable to answer individual emails. Thank you.

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