Laparoscopic Assisted Vaginal Hysterectomy in Prolapse Situations
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For the prolapse uterus, laparoscopic assisted vaginal hysterectomy (LAVH) takes advantage of the loose vagina route and is superior to the total laparoscopic hysterectomy (TLH). Four steps compose LAVH: laparoscopic dissecting, vaginal dissecting, laparoscopic hemostasis and routine cystoscopy. The dissecting starts from the bilateral round ligaments, tubes and ovarian ligaments. Bilateral anterior leaves of broad ligaments are opened and merged together in the junction of vesico-uterine fold. Bilateral posterior leaves of broad ligaments are dissected to the points near proximal utero-sacral ligament. Laparoscopic dissecting ends in coagulation and dissection the uterine vessels down to the uterine arteries with or without transection of which. The vessels below the uterine arteries are dissected through vaginal approach. The procedures of vaginal dissecting also contain specimen retrieval and the closure of vaginal cuff. After laparoscopic hemostasis, a routine cystoscopy is recommended to check the patency of bilateral urinary tracts and the integrity of bladder mucosa.