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What Happens During Laparoscopically Assisted Vaginal Hysterectomy?

Clip Number: 15 of 40
Presentation: Women's Health -- Common Conditions, Tests, and Procedures
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Reviewed By: Arthur Schoenstadt, MD
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Now, let's talk about the surgery.
After you have anesthesia, your feet will be put into stirrups. This is like when you are having your annual pelvic exam. To make the area as clean as possible, your vagina, pelvic area, and lower abdomen will be washed with a special disinfectant solution. You will be covered with sterile sheets. A catheter, which is a plastic, flexible tube, will be placed into your bladder. This drains and measures your urine during the surgery.
Your doctor will then put a speculum into your vagina. The speculum helps to keep your vagina open so the doctor can see your cervix. A small instrument will then carefully be placed into the end of your cervix. This makes it possible for your doctor to gently move the uterus into different positions, so that your pelvic structures can be seen more clearly through a special camera called a laparoscope.
To put the laparoscope inside your abdomen, your doctor will first make an incision in, or just below, your navel. A tube, called a trocar, will then be inserted into your abdomen. Through the trocar, your doctor will fill your abdomen with carbon dioxide gas, which is like the air you breathe out. This gas helps your doctor see your pelvic structures more clearly. The laparoscope is then inserted. Through this, your doctor can look at the inside of your abdomen on a video screen. The laparoscope can also take pictures and videotape the surgery.
After looking at all of your organs, your doctor will decide if it is safe to do the surgery with the help of the laparoscope. Your doctor might find something that makes it impossible to take out your uterus through the vagina. If this happens, he or she could change the surgery to an abdominal hysterectomy.
For the next part of the surgery, your doctor will make two or three other small incisions in your abdomen. These incisions are for other tools that your doctor will need during your operation.
The next part of the surgery happens through the vagina. The laparoscope will still be inside your abdomen while this part of the surgery happens.
An incision is then made through the cervix. When all the tools are in the right place, in your vagina and abdomen, the uterus will be separated from the organs, ligaments, and blood vessels that are attached to it.
After this is done, the uterus is carefully pulled out through the vagina. If the ovaries and fallopian tubes are to be removed, they will be taken out after the uterus. Then, the top part of the vagina is stitched closed, and the instruments are removed. The incisions are then closed with stitches and covered with a bandage.
Gauze may be put into the vagina after the surgery to help prevent bleeding from your incision. It will be taken out shortly after the surgery.
The entire surgery usually takes one to three hours.

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