Vaginal Hysterectomy Assisted with Laparoscopy

What is a vaginal hysterectomy assisted with laparoscopy?

A vaginal hysterectomy is surgery to remove the uterus through the vagina. The uterus is the muscular organ at the top of the vagina. Babies develop in the uterus, and menstrual blood comes from the uterus.

In a vaginal hysterectomy assisted with laparoscopy, the doctor uses a tool called a laparoscope to help with the removal. A laparoscope is a thin tube with a light and tiny camera.

When is it used?

There are many reasons why you and your healthcare provider may decide to take out your uterus. Some of the problems that may be treated with a vaginal hysterectomy are:

• tumors in the uterus
• constant heavy bleeding that has not been controlled by medicine or dilatation and curettage (D&C)
• endometriosis that causes pain or bleeding and does not respond to other treatments
• chronic pelvic pain
• a fallen (sagging) uterus
• precancerous or cancerous cells or tissue on the cervix.

Examples of possible alternatives to a vaginal hysterectomy are:

• having your uterus removed through a cut in your abdomen (abdominal hysterectomy)
• taking medicines to treat some types of problems
• having a hysteroscopy or laparoscopy
• continue having D&Cs to control abnormal bleeding
• choosing not to have treatment, recognizing the risks of your condition.

You should ask your healthcare provider about these choices.

How do I prepare for this procedure?

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

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Be sure to tell your healthcare provider what medicines you are taking, including nonprescription drugs and herbal remedies.

Follow any other instructions your provider gives you. 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 provider may give you a laxative to take the night before the surgery or an enema the morning before the surgery.

What happens during the 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 and causes a deep sleep. It will prevent you from feeling pain during the procedure.

You will have an IV in your arm to give you fluids and medicines. Usually a catheter (small tube) is placed into your bladder through the urethra (the tube from the bladder to the outside). The catheter drains the bladder.

Your peritoneal cavity, which holds most of your abdominal and pelvic organs, is inflated with carbon dioxide gas. This expands your peritoneal cavity like a balloon and helps the doctor see your organs. The doctor makes a very small cut (puncture) in your abdomen and inserts the laparoscope. The doctor looks through the laparoscope and finds your uterus.

Through two other punctures 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 ligaments and other tissue around the vagina have stretched from aging or childbearing, the doctor may repair the walls of your vagina by sewing the ligaments together. (Ligaments are fibrous tissues that help support organs and hold them in place.) The vagina is then attached to the repaired ligaments and the top of the vagina is sewn closed.

What happens after the 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 stay in the hospital longer or go home with the catheter to drain your urine until the bladder starts working well again. Your provider will check how well your bladder is working at a follow-up visit.

After you go home, get plenty of rest. Do not do any heavy lifting or otherwise strain the stomach muscles for 4 to 6 weeks. Follow your healthcare provider's instructions for activity, dealing with pain, and preventing constipation. Ask your provider what other steps you should take and when you should come back for a checkup.

If you were having menstrual periods before the surgery, you will no longer have them after the operation. You also cannot become pregnant. If you have concerns about this, discuss them with your healthcare provider before the surgery.

What are the benefits of this procedure?

A hysterectomy takes care of problems you may have been having with your uterus. For example, it removes any tumors that may have been in your uterus and it stops menstrual periods. Also, with this procedure, there will be only small punctures in your abdomen from the laparoscope. This means you will probably have less pain and discomfort after this operation than if your uterus were removed through a cut in your abdomen. Recovery is usually faster from a vaginal hysterectomy than from an abdominal procedure. You may be able to leave the hospital sooner. The vaginal procedure does not leave a visible scar.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• 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.
• If your blood vessels leak or are injured, your healthcare provider may open your stitches to stop the bleeding.
• Your bladder or rectum might be injured and need repair.
• The tubes leading from your kidneys to your bladder (ureters) could be injured and need surgical repair.
• If your doctor has trouble removing your uterus through the vagina, it may be removed through an abdominal cut instead.
• You may develop an infection or bleeding.
• You may have nausea and vomiting.
• You may develop a hernia in the top of the vagina.
• Sometimes the carbon dioxide gas that is used to inflate your peritoneal cavity will cause pain in your right shoulder. It usually goes away after a day or two of bed rest.
• You may develop a blood clot in your legs, pelvis, or lungs.

Your healthcare provider may give you some medicines to help with some of these problems. Ask your provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You develop a fever over 100°F (37.8°C).
• You cannot urinate or you have pain or a burning feeling when you urinate.
• You have pain in your abdomen or your abdomen becomes swollen.
• You become dizzy or faint.
• You have nausea and vomiting.
• You become short of breath or have chest pain.
• You develop a rash.
• You have heavy bleeding from the vagina.
• You have swelling, redness, or pain in your leg.

Call your provider during office hours if:

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