LASH Handout

LASH-LAPAROSCOPIC SUPRACERVICAL HYSTERECTOMY

Lash is a specialized advanced Gyn surgery procedure. It is the removal of part of the uterus through small incisions using a Laparoscope. The uterus is a reproductive organ ion the female pelvic area. It holds the fetus during pregnancy. When a woman is not pregnant, the uterus sheds its lining each month during menstruation.
Many variations of Gyn surgery can be done in women who have significant problems wioth the uterus. If surgery is medically required or a reasonable option for a woman, and she has no plan for future pregnancies, then we like to consider LASH as a possibility. A hysterectomy involves the surgical removal of the entire uterus. When it is removed through an incision in the abdomen, the procedure is called an abdominal hysterectomy or TAH. When it is removed through the vagina, it is called a vaginal hysterectomy or TVH. When it is removed with the assistance of a laparoscope through small incisions, it is called a laparoscopic hysterectomy or LAVH. After a laparoscopic hysterectomy, women often have less pain, a shorter hospital stay, and quicker recovery time than after an abdominal hysterectomy.
LASH involves the use of a small telescope-like device called a laparoscope. The laparoscope is inserted into the abdomen through a small incision in the navel. It brings light into the abdomen so the Gyn surgeon can see inside. He views the organs on a special TV-like monitor screen. The organs are easily seen and magnified to make the surgery easier.
During laparoscopy, other incisions are made in the abdomen. These allow the Gyn surgeon to insert other devices, such as lasers, tiny scissors and stitches to perform the surgery, and remove diseased organs. Special instruments, such as endo-bags and morcellators, allow the safe removal of large amounts of tissue through small incisions.
The LASH procedure removes the diseased part of the uterus, but leaves the ovaries and cervix intact. LASH is the least invasive technique for long-term treatment of most bleeding and pain problems, when other simpler treatment fails. Saving the cervix leaves the vagina undisturbed. This seems to eliminate any chance of change in sexual response or pelvic support that may rarely occur with a hysterectomy. The ovaries are usually preserved so they may continue to produce hormones and avoid “surgical menopause”. Diseased ovaries can be removed or treated at the same time as the LASH is done.
Women who have a simple LASH procedure cannot become pregnant and stop having periods. LASH is only an option for women who do not plan to become pregnant.
REASONS FOR A LASH
A number of variations in hysterectomy and related procedures may be offered as treatment options for problems with the uterus. Following are reasons to perform the LASH procedure.
EXCESSIVE OR PAINFUL PERIODS: The most common conditions that require a LASH, involve problems that create heavy or prolonged bleeding or excessive menstrual pain. After a LASH, there is no more menstrual bleeding and most symptoms and discomfort associated with periods is gone as well.
ENDOMETRIOSIS: In this condition, patches of tissue that normally line the uterus grow outside the uterus and grow on other pelvic or abdominal organs. This may lead to painful cysts, scarring, infertility, and /or severe adhesions. The Gyn surgeon can use laparoscopic laser techniques to treat the endometriosis and to do the LASH procedure.
FIBROIDS: Fibroids are benign (non-cancerous) growths on the uterus. If they are large or cause significant bleeding, pain, or infertility, they can be removed from the uterus. Removing the fibroids only is called a myomectomy. Removing the fibroid part of the uterus is a form of the LASH.
PROLAPSE OR”DROPPED UTERUS”: Many women suffer from uterine prolapsed, where the uterus drops lower into the vaginal canal and causes pelvic pressure, pain, or discomfort with intercourse. This can be repaired with or without the LASH.
ADHESIONS: Adhesions are bands of scar tissue that can cause the pelvic organs to stick together. They may occur in the abdomen because of past surgeries, endometriosis, other disease or pelvic infection. By using the laparoscopic technique, the Gyn surgeon can cut and remove adhesions to free the uterus.
SALPINGO-OOPHORECTOMY: If the ovaries and fallopian tubes are also removed during a hysterectomy, it is called salpingo-oopherectomy. One or both ovaries can be removed at the time of the LASH, if necessary. Usually it is best to try and preserve at least one functioning ovary.
Dr. Swor and you will discuss whether the LASH procedure is the best approach for you. If you have any questions regarding the LASH, please feel free to call us at Swor Women’s Care at 941-330-8885. We also have a great deal of information on our website at www.sworcare.com.
Once surgery is planned and scheduled, our surgical coordinator will verify your insurance benefits, and answer any questions leading up to the procedure, the surgery itself and the post operative course. In some cases, labwork or other testing may be arranged prior to surgery.
We schedule all patients for a consultation with Dr. Swor, before surgery to review the treatment plan, the procedure and answer any other questions.
THE PROCEDURE:
Before the LASH, certain steps will be taken to prepare you for the procedure after you arrive at the surgery center.
You will be asked to complete medical information forms and sign a consent for the procedure.
You may be asked if your doctor marked your abdomen to indicate a surgery site that will be treated (such as the right or left ovary).
You will be given an intravenous line IV.
You will be given some form of anesthesia. Most patients are under general anesthesia.
During the LASH procedure, you will lie on your back as for a pelvic exam. The procedure most often follows these basic steps.
1. The surgeon will make a small incision near the naval. The laparoscope is inserted through this incision into the abdomen. A harmless carbon dioxide gas is also put into your abdomen through this incision The gas expands the space around your pelvic organs so the the surgeon has enough room to look around and move them The surgeon can also see your pelvic organs on a special TV-like monitor.
2. The surgeon will usually make one or more other small incisions in the abdomen. These incisions are used to insert devices to move the pelvic organs and help remove the uterus. Devices that may be used include scissors, forceps (grasping device), clamps, stitches, and metal clips. The attachments and blood vessels to the upper uterus are separated surgically.
3. A cut is made where the upper uterus joins the cervix. The bladder is gently pushed off the uterus. Then the upper portion of the uterus and other diseased tissue is removed through one of the incisions using a morcellator. The morcellator cuts the tissue to be removed into small pieces so that the incisions can be kept small.
4. The incisions in the abdomen and the remaining cervix are repaired with stitches. After the LASH, you will have some small incisions on your abdomen which will need special attention during healing. Usually, we use small stitches that dissolve under the skin and inside the body.
Our statistics and years of experience show that most patients who have the LASH procedure are 80% recovered at one week post surgery. We allow most patients to return to regular activities after one week. Moderate exercise and sexual activity can be safe after 2 weeks. Heavy exercise, strenuous jobs or activities will require additional time. If other procedures are done at the same time, then extra time may be required for healing. Our patient follow up surveys taken over the years indicate a very high level of satisfaction with the LASH procedure.