difference between vaginal hysterectomy and LAVH

Hi - I have surgery scheduled 12/29. I have a fibroid about the size of a grapefruit, pressure, bladder issues and other symptoms caused by the fibroids. My doctor is planning a vaginal hysterectomy - but not a LAVH. He hasn't even mentioned that as an option. He said that the fibroid might be a challenge to remove vaginally but he thought they could do it? Now, my question is, why would a doctor NOT use a laprascope? Is there a downside to this? Maybe he is not trained to use this method? I don't have any reason to think that he is not current - but all of the posts and discussion talking about LAVH are making me concerned ....
Thanks in advance for any insight you might have!

Does anyone know why a physician would chose TVH over LAVH? Thanks so much for any info you can share. I am getting really nervous.

if you go to the top of the site to alternatives, you can read the difference between the two. one involves using the lap, one doesnt use it. both remove the uterus and cervix. i dont know too much about why one would be chosen over the other since i had the lsh (kept my cervix).
good luck with your surgery and recovery!

Hi I had a TVH; my surgery was for a severe prolapse. Since my uterus was already visible to me, the surgeon didn't need any extra help from a camera to see what she needed to see. Besides, it was already too low for laparascopic incisions to be of much help.

Surgeons who are very experienced at doing TVHs often don't feel the need to have 3 incisions and a camera complicating their procedure. It takes a lot of skill to do a TVH, especially removing the ovaries as well; my surgeon didn't have any trouble finding my ovaries and removing them vaginally.

An LAVH might be helpful if it's anticipated that once in there, the surgeon might find endo or adhesions which might need to be excised in order to remove the uterus; then, a camera could be useful.

Did you ask your DR why he elected to do a TVH on you rather than an LAVH? Make sure you get all your questions answered before going into surgery. And let us know what he says, OK?

Good luck with your surgery!

s,
-Linda

Hi - just a question - why did you decide to keep your cervix. My doctor says there is really no reason to keep it -

Thanks for your response and the info.

Thanks - that makes sense and is what a friend suggested to me today. He is an experienced doctor and probably just does not want/need to make the extra incisions for the laprascope.

I would get a second and even third opinion. I have the same issue with a very large 11x9cm fibroid. My original OBGYN said TVH.... I've had 3 other opinions and each of them have said NO to the TVH and LAVH... they have all said the fibroid size and location would make it very difficult to do vaginally and may result in TAH during the procedure anyway. I'm actually going for my 4th opinion today to get more info. on the Davinci robotic procedure that is done abdominally, but also laprocopically.

Questions4you,

Like Dressedupinblue I had the LSH. I wanted that particular procedure because I watched the videos, read up on the options and felt that for large fibroids it was the best for me.

The lap incisions are small and should heal faster than the work done inside no matter what the procedure. So to me they were almost a non-issue. The camera allows a visualization, imagine trying to see anything vaginally. If there is anything else going on in there it could be easily missed or end up needing a big incision JMHO. I didn't want a big incision and the six plus weeks of recovery. I also didn't want a vaginal cuff, if avoidable, with its recovery time. The LSH doesn't leave a need for a vaginal cuff.

There are lots and lots of successful TVHs done by excellent DRs, I'm not saying there is anything wrong with them. With the LSH as an option, I picked it. Not all DRs are trained in or comfortable with the lap procedures. If you want a lap surgery find a DR that is experienced doing them. Ask your DR for a referral.

I don't know why a DR would do a TVH vs a LAVH. I've wondered about that myself. I guess some DRs are just comfortable with what they know. A grapefruit sized fibroid removed vaginally?? Thats like giving birth! Does make you wonder. The lap assist won't make that fibroid any smaller unless he is using a morcellator which is worth asking about.

Hope you get your questions answered, I'm curious too. Good luck.

Pat

Hi PattyPat,
What is LSH? did you have a fibroid removed also? I had my 4th and final opinion yesterday from a GYN Oncologist to discuss my risks of OVCA. My sister had it and he feels it is not worth the risk to just have the fibroid removed, need total hyst. wow.... really didn't want to do that. He also recommended a LAVH which I was shocked about. This is one of the top oncologists in the state. He said they would have to biopsy all tissue and couldn't if a morcelator is used is the davinci procedure. He also said there are more complications with a TAH... I don't know what to think now.