# difference between a LAVH & LTH



## karey (Dec 13, 2012)

What is the difference between a Laparoscopic vaginal hysterectomy (LAVH) and a laparoscopic total hysterectomy (LTH)?

Please don't give me a cut and paste of what the CPT code description. I need someone to explain to me the difference.

I am being told that a LAVH is when the specimen (uterus) is removed through the vagina and that a LTH is when the specimen is removed via a port. If so then I have been mis-coding and so have my docs.

According to ACOG the difference is how you detach the uterus. A TLH approach for removal is the detachement of the entire uterine cervix and body via the laparoscope (tissues removed through vagina or abdomin) and a LAVH is the detachement of entire uterine cervix and body via the laparoscope and vagina (tissues removed through the vagina). 

So how do you determine whether it is vaginal assisted? I thought if a speculum is used then it is vaginal(that's the easiest way i found to tell the diference). Should my docs be documenting differently?


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## kvangoor (Dec 17, 2012)

Here is a good explanation given by ACOG.
http://www.acog.org/About_ACOG/ACOG...e/Coding_Laparoscopic_Hysterectomy_Procedures


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## kimberlyapetro (Dec 18, 2012)

Another explanation

http://www.cdc.gov/nhsn/PDFs/commup/coding-guidance-lap-hyst-april2012.pdf


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## bonnyr (Jan 7, 2013)

Go with ACOG, not your coders & providers.  LAVH is laprascopic assisted Vaginal hys.  In other words, the uterus is removed through the vagina.  The TLH is everything done through the laprascopic incision. 
I've found that many times "the way things have always been done" may not be the correct way.


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## karey (Jan 9, 2013)

My provider has said that "Any robotic hyst is TLH, any laparoscopic hyst is LAVH" & "
Anything about sewing the vagina closed through the vagina is a LAVH"

Look at the following and tell me if you can tell the difference. The 1st one was coded as an LAVH and the 2nd a TLH

1. Attention was then turned to the hysterectomy. The infundibulopelvic ligaments were skeletonized, cauterized and transected followed by division of the broad ligament bilaterally. The round ligaments were cauterized and transected bilaterally followed by division of the vesicouterine peritoneum allowing the bladder to be reflected over the lower uterine segment, cervix and proximal vagina. The uterine arteries were then skeletonized, cauterized and transected followed by sequential cautery and transection of the cardinal and uterosacral ligaments. Once below the level of the cervix, assuring the bladder, rectum and ureters were out of surgical field, an anterior colpotomy was created and carried circumferentially around the base of the cervix separating it from the vaginal attachments. The specimen was then retrieved through the vaginal opening and handed off for pathology evaluation. The cuff was then closed using V-lock suture in a running fashion.

2. [FONT=COURIER,sans-serif]Hysterectomy was then performed.  Infundibulopelvic ligament was then
[FONT=COURIER,sans-serif]skeletonized.  It was then sequentially clamped, cauterized and cut.​
[FONT=COURIER,sans-serif]The medial leaf of the broad ligament was skeletonized.  Round ligaments [/FONT][FONT=COURIER,sans-serif]were cauterized and incised.  Anterior peritoneum was incised and [/FONT][FONT=COURIER,sans-serif]areolar tissue between the bladder and lower uterine segment sharply [/FONT][FONT=COURIER,sans-serif]dissected down to a level past the cervix.  The uterine pedicles were [/FONT][FONT=COURIER,sans-serif]then meticulously skeletonized.  Anterior and posterior colpotomies were [/FONT][FONT=COURIER,sans-serif]made. After that, uterine pedicle, cardinal ligament, uterosacral [/FONT][FONT=COURIER,sans-serif]ligament were successfully clamped, cauterized and cut in the usual [/FONT][FONT=COURIER,sans-serif]fashion. Further paravaginal pedicles were created and cauterized.  At [/FONT][FONT=COURIER,sans-serif]all times the bladder was retracted inferiorly and the ureters laterally [/FONT][FONT=COURIER,sans-serif]out of the field of dissection.  Further vaginal incisions were made.[/FONT][FONT=COURIER,sans-serif]Specimens were all removed through the vagina.  The remainder of the [/FONT][FONT=COURIER,sans-serif]vagina was closed with interrupted 0 Maxon sutures. [/FONT]​[/FONT][/FONT]


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