LAVH: After pre-Op hysterectomy appointment, feeling confused: TLH to be performed vaginally?

Ok, so I am hoping you all can help me understand my doctor. I had my pre-op yesterday and she is telling me that I will be having a "Total Laparascopic Hysterectomy" (TLH) and she's said this several times now. When I pressed her for more details, she says the surgery will be laparascopic and the unterus/cervix/tubes will be pulled out through the vagina.

I'm actually HAPPY about this after everything I've read about morcellation. I don't want my uterus (with multiple fibroids) morcellated inside my abdomen, but why does she continually refer to this as a TLH and not an LAVH? Even my consent form said "TLH," but then it said, "Uterus, tubes, cervix to be removed vaginally." Everything I am reading tells me that if the Uterus is removed vaginally, then it's a VAGINAL hysterectomy, even if laprascopy is used.

I am wondering if my doc does not want to admit that she doesn't have the knowledge/experience to do "True" TLH surgeries? Maybe she underestimates my ability to research this stuff?

Thank you for any advice you may have!!

In case anyone wants to know more about this.. I solved my own mystery, so it seems.

I had read on HysterSisters.com and many other sites that TLH included the removal of the uterus in pieces through tiny abdominal incisions. So, I was under the impression that TLH simply never included vaginal removal/vaginal incision.

After a more exhaustive Google search, I have discovered that TLH can include removal of the uterus/cervix/tubes via the vagina - but it's still considered a Lap surgery, rather than a vaginal surgery - the differences are subtle. I found 4 reputable websites (including JohnsHopkins and Medscape) that confirmed this- I am still not clear on the pros and cons between LAVH vs.Vaginal TLH..... it just sounds like LAVH is the precursor to Vaginal TLH.... but both are very similar.

I will have to change my surgery type from LAVH to TLH now. Too funny.

HysterSisters Moderators.. I do think the TLH description on this site needs to be more clear that TLH does not always mean "removal" via the abdomen. Removal can also be done vaginally.

Very interesting! Thanks for posting what you found out!
I did read a thread on this site where someone found out post surgery that during her TLH the cervix was removed vaginally.

I had the same description for my surgery-TLH. I had six key hole incisions and everything was removed vaginally. I had my surgery a few months ago. When I went to my pre-op I had the same mis-understanding. My surgeon does not do morcellation. My uterus was massive and needed to be cut in order for it to be removed vaginally. Good luck with your surgery and happy healing.

To give you one more thing to think about/research... The true definition of morcellation is to cut - whether the cuts are manual or machine made.
My uterus is the equivalent of 14 weeks with embedded and external fibroids. My Dr won't do a vaginal or true laparoscopic surgery because both would involve morcellation - cutting for removal.
Every situation is different and every Dr is different. Best thing you can do is ask questions. Don't feel like you're being a bother. It's your body, a major surgery and you should have the information!

One thing I did ask was about morcellation/cutting of the uterus. My doc assured me there would be no "cutting up" of the Uterus/cervix INside the body.....so I have to take her word on that. She has mentally prepared me for TAH if she cannot successfully get everything out due to the fibroids or if there are other complications. Hoping for the best outcome!

	Quote:
Originally Posted by rockymtn1971 One thing I did ask was about morcellation/cutting of the uterus. My doc assured me there would be no "cutting up" of the Uterus/cervix INside the body.....so I have to take her word on that. She has mentally prepared me for TAH if she cannot successfully get everything out due to the fibroids or if there are other complications. Hoping for the best outcome!

Glad you knew the right questions to ask! What did we do before the Internet???
Whatever the outcome is it will be the best for you!
Wishing you good health and recovery!

	Quote:
Originally Posted by rockymtn1971 In case anyone wants to know more about this.. I solved my own mystery, so it seems. I had read on HysterSisters.com and many other sites that TLH included the removal of the uterus in pieces through tiny abdominal incisions. So, I was under the impression that TLH simply never included vaginal removal/vaginal incision. After a more exhaustive Google search, I have discovered that TLH can include removal of the uterus/cervix/tubes via the vagina - but it's still considered a Lap surgery, rather than a vaginal surgery - the differences are subtle. I found 4 reputable websites (including JohnsHopkins and Medscape) that confirmed this- I am still not clear on the pros and cons between LAVH vs.Vaginal TLH..... it just sounds like LAVH is the precursor to Vaginal TLH.... but both are very similar. I will have to change my surgery type from LAVH to TLH now. Too funny. HysterSisters Moderators.. I do think the TLH description on this site needs to be more clear that TLH does not always mean "removal" via the abdomen. Removal can also be done vaginally.

My doctor told me he wanted to do laproscoptic surgery, because my uterus was 'too high' and it never 'dropped' like women who have more than one child. He said he wouldn't be able to see what he was doing through the vagina. I have 3 laproscoptic 'holes' and I had uterus, cervix, and tubes removed. I don't know if everything was removed through the vagina or not, because I was still drugged up after surgery when he was talking to me. I don't really any pain in the vagina section, so I don't know...