# TLH vs LAVH



## esmadigan (Aug 16, 2011)

I want to confirm with anyone coding TLH and LAVH cases - My understanding is for a hyst to be a true TLH, anything (uterus, etc) being removed MUST be morselized and removed thru the scope.  If anything is removed thru the vagina then it is considered a LAVH, correct?


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## sknapp56 (Aug 16, 2011)

My understanding is with the LAVH not all of the structures are detached laparoscopically and the uterus is removed through the vagina. The TLH is where all structures are detached laparosocpically and can be removed through the uterus or vagina. The AAPC did a hysterectomy webinar last year that might be helpful to you.


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## preserene (Aug 16, 2011)

I have already posted the meaning of these procedures an year ago I think.
See whether it is helpful. 
Here we go:

LAVH- Laparoscopy” assisted “Vaginal Hysterectomy- laparoscopy is used as an aid to Hysterectomy. In LAVH, laparoscopic inspection at the end of the procedure permits the surgeon to control any bleeding and evacuate clots. Laparoscopic cuff suspension may limit future vault prolapse. 
BUT, we should know there are many varieties of lapraroscopy “USED” vaginal hysterectomy.
In Laparoscopy used vaginal Hysterctomy itself, there are variety .of surgeries- like: : 
a) Diagn. Laparoscopy with vaginal hyst - Lap used for diagnostic purposes to determine if Vag. Hysterectomy is possible and also to ensure vaginal cuff and pedicle hemostasis and allows clot removal .
b) Lapro. assisted vaginal Hysterectomy [LAVH] – A VAGINAL HYSTERECTOMY AFTER LAPAROSCOPIC adhesiolysis,endometriosis excision or oopherectomy.
c) Laparoscopic Hysterctomy[LH] - Laparo. Ligation of uterine artery either by electro surgery, suture ligature or staples. All surgical steps after the uterine vessels desiccation, can be performed either VAGINALLY or laparascopically. LAPAROSCOPIC LIGATION OF THE UTERINE VESSELS IS THE SINE QUANON FOR LAPAROSCOPIC Hysterectomy. Identification of the URETER is always advised.
d) Total Laparoscopic Hysterectomy [TLH] – here the laparoscopic dissection CONTINUES until the uterus lies free of all attachment in the peritoneal cavity. The uterus is removed through the vagina with morcellation if necessary… The vagina is closed with sutures applied laparoscopically . NO VAGINAL SURGERY IS DONE UNLESS MORCELLAITON IS NECESSARY. Laparoscopic hysterectomy includes all cases using the laparoscope.

{ LAVH is REALLY a vaginal Hysterectomy [almost all LAVH CAN BE DONE AS COMPLETE VAGINAL HYSTERECTOMY]. 
Total lapro. Hysterectomy [TLH] implies that a Vaginal Hysterectomy will be difficult or impossible to perform ( ie)TLH IS A SUBSTITUTE FOR ABDOMINAL HYSTERECTOMY but not for vaginal hysterectomy.}

e) Lapro. Supracervical Hysterectomy[LSH] - is a less risky procedure with decreased risk of ureter dissection. The uterus is removed by morcellation from above or below.

f) LAPAROSCOPIC. Pelvic Reconstruction [LPR] WITH VAGINAL HYSTERECTOMY.

I hope this could help you to differentiate between them and to assign codes accordingly.


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