It can not always be done for massive uteruses, and it is almost impossible to do for women who have never delivered babies vaginally. It is also not always possible to remove the ovaries because they are attached much higher in the pelvis than the uterus and cannot always be pulled down into the vagina for surgical removal. It is done this way because of suspicions that the ovaries probably cannot be disconnected by operating only through the vagina. LAVH is performed on women who can have a vaginal hysterectomy but need to be certain the ovaries are removed, or who have had surgeries which make the vaginal route alone more risky or less successful. There still must be vaginal laxity and openness.
Abdominal scars consist of two to four half-inch incisions.
Usually two days in the hospital are needed with two weeks away from work. This is the next most preferred route for qualifying women. This procedure involves disconnecting the uterus, and other structures as needed, by operating only through the laparoscopes in the abdomen, starting at the top of the uterus. Then all tissue to be removed is passed through the vagina or through the tiny half-inch abdominal incisions. If the uterus is massively enlarged it can be disconnected from its attachments, then cut into tiny pieces and passed down the vagina.