Laparoscopic-Assisted Vaginal Hysterectomy (LAVH): How It Works, Risks and Recovery

A laparoscopic-assisted vaginal hysterectomy, usually shortened to LAVH, is a way of removing the uterus that combines two techniques. The surgeon starts with keyhole (laparoscopic) surgery through a few small cuts on the belly, then finishes the operation through the vagina, which is also where the uterus comes out. This guide explains how LAVH differs from the other types of hysterectomy, why a surgeon might suggest it, what the research shows about its results and risks, and what recovery usually looks like.

The short answer

• What it is: part keyhole surgery, part vaginal surgery. The first steps are done with a camera and thin instruments through small cuts on the abdomen; the rest is done through the vagina, and the uterus and cervix are removed that way.^[2]
• Why it is used: it lets the surgeon look inside the pelvis and free the uterus, tubes or ovaries from above when a purely vaginal operation would be difficult, while still avoiding a large open cut.^[1][3]
• Compared with open surgery: trials of laparoscopic hysterectomy, a group that includes LAVH, show a return to normal activities about two weeks sooner than after abdominal hysterectomy, with a shorter hospital stay and fewer wound infections, but a higher risk of injury to the ureter (the tube that drains the kidney).^[2]
• Compared with a vaginal hysterectomy: results are similar, but LAVH takes longer and costs more. When a vaginal hysterectomy is possible, US and international guidance prefers it.^[1][2][4]
• Recovery: many people go home within 1 to 4 days. Most feel much better after about two weeks and close to normal at 4 to 6 weeks, though energy can take 6 to 8 weeks to return.^[9][10]

What “laparoscopic-assisted” means

Every hysterectomy has the same basic job: the uterus is cut free from the ligaments and blood vessels that hold it in place, and then it is taken out. The different types of hysterectomy are named after how the surgeon reaches the uterus and where it leaves the body.

In an LAVH, the operation is split in two. The upper part is done laparoscopically: the surgeon looks inside with a camera and uses long, thin instruments to divide the upper supports of the uterus and, if planned, to remove the fallopian tubes and ovaries. The surgeon then moves to the vaginal side, opens the top of the vagina around the cervix, divides the lower supports and main blood vessels, and removes the uterus and cervix through the vagina.^[2] Exactly how much is done from above and how much from below varies between surgeons and patients.

Because the cervix is removed, an LAVH is a total hysterectomy, not a partial one. If you are not sure which of these you are having, our guide to partial vs total hysterectomy explains the difference.

How LAVH compares with the other routes

Type	Cuts on the belly	How the uterus is freed	How it comes out
Vaginal hysterectomy	None	Entirely through the vagina	Through the vagina
LAVH	Several small cuts	Upper part by keyhole surgery, lower part through the vagina	Through the vagina
Total laparoscopic hysterectomy (TLH)	Several small cuts	Entirely by keyhole surgery	Usually through the vagina
vNOTES	None	Keyhole instruments passed through the vagina	Through the vagina
Abdominal (open) hysterectomy	One larger cut	Through the open abdomen	Through the abdominal cut

You can read more about each option in our guides to vaginal hysterectomy, laparoscopic hysterectomy and vNOTES hysterectomy. A robotic operation is a form of laparoscopic surgery, so it can also be done as a robotic-assisted LAVH.

Why a surgeon might suggest LAVH

The American College of Obstetricians and Gynecologists (ACOG) advises that, for non-cancerous conditions, a minimally invasive hysterectomy should be done whenever it is feasible, that the vaginal route is preferred among these, and that laparoscopic hysterectomy is a better alternative to open surgery when a vaginal hysterectomy is not possible or not suitable.^[1] LAVH sits between those two options. ACOG lists the factors that shape the choice of route:^[1]

• the size and shape of the uterus and the vagina, and how easy the uterus is to reach;
• whether there may be disease outside the uterus, such as endometriosis or scar tissue (adhesions) from earlier surgery;
• whether other procedures are planned at the same time, such as removing the ovaries;
• the surgeon’s training and experience, and the equipment and support available at the hospital;
• whether the operation is planned or an emergency, and the preferences of the informed patient.

In practice, the laparoscopic step can help when the surgeon wants to check the pelvis before committing to a vaginal approach, needs to separate scar tissue, or wants to remove ovaries that are hard to reach from below. In the large UK eVALuate trial, the laparoscopic operations found unexpected disease more often than vaginal hysterectomies did (16.4% vs 4.8%).^[3] The keyhole part does have a cost: it adds operating time and equipment, so it is most useful when it changes what can be done safely.

Hysterectomy for a known or suspected cancer is planned differently, often by a gynecologic oncologist. If that applies to you, see our guide to radical hysterectomy for cervical cancer and ask your team which approach they recommend and why.

How an LAVH is done, step by step

Details vary between hospitals, but the operation usually follows these steps:

1. Anesthesia: you have a general anesthetic, so you are asleep throughout. A thin tube (catheter) is usually placed in the bladder.
2. Small cuts on the belly: the surgeon makes a small cut, often at the belly button, and several others lower on the abdomen. The belly is filled with carbon dioxide gas to create space, and a camera is passed in.
3. The laparoscopic part: watching on a screen, the surgeon divides the upper attachments of the uterus and, if planned, removes the fallopian tubes and ovaries. Any scar tissue can be separated at this stage.
4. The vaginal part: the surgeon makes a cut around the cervix at the top of the vagina, divides the remaining supports and the main blood vessels, and removes the uterus and cervix through the vagina.
5. Closing: the top of the vagina is stitched closed with dissolvable stitches, creating what is called the vaginal cuff. The surgeon often takes a final look with the camera, lets the gas out and closes the small cuts on the belly.

How long it takes depends on the size of the uterus, scar tissue and the surgeon’s experience. In trials, laparoscopic operations took roughly 30 to 40 minutes longer on average than vaginal hysterectomies.^[3][4][5] The small cuts usually heal into short scars; our page on hysterectomy scars shows what the different types look like.

What the research shows

The best overview is a 2023 Cochrane review of 63 randomized trials with 6,811 women. It treats LAVH as one kind of laparoscopic hysterectomy, together with total laparoscopic and single-port hysterectomy, so most of the findings below apply to that whole group.^[2]

LAVH vs abdominal hysterectomy

Compared with open surgery, laparoscopic hysterectomy meant a return to normal activities about 13 days sooner (around 3 weeks instead of 5 in the trials), a shorter hospital stay, fewer wound infections and fevers, and fewer blood transfusions. The trade-off was a longer operation and more injuries to the ureter: the review estimates that if the ureter injury rate is 0.2% with open surgery, it would be between 0.2% and 2% with laparoscopic surgery.^[2]

LAVH vs vaginal hysterectomy

Here the studies point the same way. A meta-analysis of 9 randomized trials that compared LAVH directly with vaginal hysterectomy found similar complications, blood loss, hospital stay and need to switch to open surgery, but LAVH took about 40 minutes longer; the authors concluded that vaginal hysterectomy should be used routinely when possible.^[4] A South African trial in women without prolapse found the same, and LAVH cost about US $1,150 more per operation, mainly because of operating time and disposable equipment.^[5] An Egyptian trial in women with large uteri (280 to 700 grams) found both operations safe, with the vaginal one cheaper.^[6] The Cochrane review found no clear difference in return to normal activities, but shorter operations and hospital stays with the vaginal route.^[2]

LAVH vs total laparoscopic hysterectomy

Only three small randomized trials (233 women) have compared these two directly, and the Cochrane review could not say whether either has fewer injuries or long-term problems.^[2] One difference that has been studied is how the top of the vagina heals. In a large US hospital study, the rate of the vaginal cuff opening up after surgery (cuff dehiscence) was 0.75% after total laparoscopic hysterectomy and 0.46% after LAVH in 2006 to 2009; over ten years the risk after total laparoscopic hysterectomy was about five times that after LAVH.^[7] This is a rare complication with either method.

A caution applies to all of this research: serious complications are uncommon, so many trials were too small to detect differences, and the surgeon’s own experience, which is hard to measure, may matter as much as the method.^[2][3]

Risks and possible complications

LAVH is major surgery, even though the cuts are small. The main risks are:

• Bleeding, which occasionally needs a transfusion or a return to the operating room.
• Infection of the small cuts, the top of the vagina, the bladder or the pelvis.
• Injury to the bladder, ureters or bowel, which lie close to the uterus. Ureter injuries are more common with laparoscopic than with open hysterectomy, although still uncommon.^[2]
• Blood clots in the legs or lungs. You may be given compression stockings, injections or both, and getting up and walking soon after surgery helps.
• Switching to open surgery if it is not safe to continue with the planned method, for example because of bleeding or heavy scar tissue.
• Vaginal cuff problems, such as slow healing or, rarely, the stitched top of the vagina opening.^[7]
• Shoulder or upper belly pain for a day or two, caused by the gas used in keyhole surgery. It is common and usually passes quickly.
• Risks of the anesthetic, which your anesthesia team will discuss with you.

If your ovaries are removed and you have not yet reached menopause, menopause will start straight away. Our guide to surgical menopause explains what to expect and which treatments can help. Removing the fallopian tubes while keeping the ovaries is a separate decision: ACOG now supports removing both tubes completely during a hysterectomy to lower the risk of the most common type of ovarian cancer, so ask your surgeon whether this is planned.^[8]

Recovery after LAVH

Recovery after an LAVH is usually similar to recovery after other keyhole or vaginal hysterectomies. Your surgeon’s instructions come first, because advice differs between hospitals and countries. As a general guide:

• Hospital stay: after a vaginal or laparoscopic hysterectomy, many people go home between 1 and 4 days later.^[9]
• The first two weeks: these are usually the hardest. Most people can stop prescription pain medicine and become more active after about two weeks.^[10] Short walks from the first days help your circulation and bowels.
• Feeling well again: it can take at least 4 to 6 weeks to feel completely better, and 6 to 8 weeks for energy levels to return to normal.^[10]
• Bleeding and discharge: light bleeding or discharge, lighter than a period, can last up to 6 weeks. Use pads, not tampons.^[9]
• Lifting: US discharge advice is to lift no more than about 10 pounds (4.5 kg, roughly a gallon of milk) at first.^[10] Your surgeon will tell you when you can lift more.
• Driving: wait until you are off strong pain medicine, can wear a seatbelt comfortably and can make an emergency stop. For some people this is a few days, for others 2 to 6 weeks.^[9][10]
• Sex and anything in the vagina: the top of the vagina needs time to heal. The NHS says to wait at least 4 to 6 weeks, until the discharge has stopped, while US discharge instructions for laparoscopic hysterectomy advise nothing in the vagina for 8 to 12 weeks and no intercourse for at least 12 weeks.^[9][10] Ask your surgeon which they recommend for you.

For practical tips on each stage, see our week-by-week hysterectomy recovery guide.

When to call your doctor

Contact your surgeon or care team if you have any of the following after an LAVH:^[10]

• a fever above 100.5°F (38°C);
• vaginal bleeding heavier than light spotting, or passing clots;
• a vaginal discharge that smells bad, or a heavy, watery discharge;
• a small cut on the belly that bleeds, becomes red and warm, or leaks thick yellow or green fluid;
• pain that your pain medicine does not control;
• nausea or vomiting, being unable to eat or drink, or being unable to pass gas or have a bowel movement;
• pain or burning when you pass urine, or being unable to pass urine;
• swelling, pain or redness in one leg;
• a cough that does not go away.

Call 911 or go to the emergency room if you have chest pain, trouble breathing, heavy bleeding, or sudden severe pain in your belly or pelvis.

Questions to ask your surgeon

• Why do you recommend LAVH for me instead of a vaginal or total laparoscopic hysterectomy?
• How many of these operations do you do each year?
• Will my ovaries and fallopian tubes be removed, and why?
• What would make you switch to open surgery during the operation?
• How long will I likely stay in the hospital, and how much time should I take off work?
• When can I drive, lift, exercise and have sex again?

Our list of things to do before your hysterectomy can help you prepare.

Frequently asked questions

Is LAVH the same as a laparoscopic hysterectomy?

It is one kind of laparoscopic hysterectomy. In a total laparoscopic hysterectomy, the whole uterus is freed with keyhole instruments. In an LAVH, only the first part is done that way and the operation is finished through the vagina.^[2]

Is the cervix removed in an LAVH?

Yes. The uterus and cervix are removed together through the vagina, so it is a total hysterectomy. A supracervical (partial) hysterectomy, which keeps the cervix, is a different operation.

Are the ovaries removed during an LAVH?

Not necessarily. The ovaries can be removed or kept, and that decision is separate from the choice of route. Being able to reach the ovaries more easily from above is one reason surgeons use the laparoscopic step when they are being removed.

How long does an LAVH take?

It varies with the size of the uterus, scar tissue and the surgeon. In the UK eVALuate trial, laparoscopic hysterectomies took 72 minutes on average.^[3] In a South African trial, LAVH took about an hour on average, compared with about half an hour for a vaginal hysterectomy done by the same unit.^[5]

Will I have scars?

You will have a few small scars on the belly from the keyhole cuts, usually one near the belly button and others lower down. There is also an internal scar at the top of the vagina, which you cannot see.

Where can I find more answers?

Our hysterectomy FAQ answers common questions about all types of hysterectomy.

Sources

1. American College of Obstetricians and Gynecologists. Committee Opinion No. 701: Choosing the route of hysterectomy for benign disease. Obstetrics & Gynecology. 2017;129(6):e155-e159.
2. Pickett CM, Seeratan DD, Mol BWJ, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database of Systematic Reviews. 2023;8:CD003677.
3. Garry R, Fountain J, Mason S, et al. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ. 2004;328(7432):129.
4. Guo Y, Tian X, Wang L. Laparoscopically assisted vaginal hysterectomy vs vaginal hysterectomy: meta analysis. Journal of Minimally Invasive Gynecology. 2013;20(1):15-21.
5. Chrysostomou A, Djokovic D, Libhaber E, et al. A randomized control trial comparing vaginal and laparoscopically-assisted vaginal hysterectomy in the absence of uterine prolapse in a South African tertiary institution. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2021;267:73-78.
6. Mohammed WE, Salama F, Tharwat A, et al. Vaginal hysterectomy versus laparoscopically assisted vaginal hysterectomy for large uteri between 280 and 700 g: a randomized controlled trial. Archives of Gynecology and Obstetrics. 2017;296(1):77-83.
7. Hur HC, Donnellan N, Mansuria S, et al. Vaginal cuff dehiscence after different modes of hysterectomy. Obstetrics & Gynecology. 2011;118(4):794-801.
8. American College of Obstetricians and Gynecologists. ACOG Clinical Practice Update: Salpingectomy for the prevention of epithelial ovarian cancer. Obstetrics & Gynecology. 2026;148(4):e275-e280.
9. NHS. Hysterectomy: recovery.
10. MedlinePlus, US National Library of Medicine. Hysterectomy – laparoscopic – discharge.

This article is for general information and is not a substitute for medical advice. Always discuss which type of hysterectomy suits you, and your surgeon’s experience with it, with your gynecologist, and contact them or emergency services if you are worried about any symptom after surgery.