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At least 19 recordsLinked to original sources

PubMed2003

Hysterectomy and sexual wellbeing: prospective observational study of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy.

OBJECTIVES: To compare the effects of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy on sexual wellbeing. DESIGN: Prospective observational study over six months. SETTING: 13 teaching and non-teaching hospitals in the Netherlands. PARTICIPANTS: 413 women who underwent hysterectomy for benign disease other than symptomatic prolapse of the uterus and endometriosis. MAIN OUTCOME MEASURES: Reported sexual pleasure, sexual activity, and bothersome sexual problems. RESULTS: Sexual pleasure significantly improved in all patients, independent of the type of hysterectomy. The prevalence of one or more bothersome sexual problems six months after vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy was 43% (38/89), 41% (31/76), and 39% (57/145), respectively (chi2 test, P = 0.88). CONCLUSION: Sexual pleasure improves after vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy. The persistence and development of bothersome problems during sexual activity were similar for all three techniques.

Adult↗

PubMed1998

A multicenter randomized comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy in abdominal hysterectomy candidates.

OBJECTIVE: To compare intraoperative and postoperative outcomes between laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy among patients who are not eligible for vaginal hysterectomy. METHODS: Study subjects were randomly assigned to undergo laparoscopically assisted vaginal hysterectomy or standard abdominal hysterectomy. Intraoperative and postoperative management was similar for each group. Surgical characteristics, complications, length of hospital stay, charges, and convalescence were analyzed. RESULTS: Sixty-five women at three institutions underwent laparoscopically assisted vaginal hysterectomy (n = 34) or abdominal hysterectomy (n = 31). Three patients in the laparoscopic group required conversion to abdominal hysterectomy. Mean operating time was significantly longer for laparoscopically assisted vaginal hysterectomy (179.8 versus 146.0 minutes). There were no differences in blood loss or incidence of intraoperative complications. There was a higher incidence of wound complications in the abdominal hysterectomy group, but no significant difference in the frequency of postoperative complications. Laparoscopically assisted vaginal hysterectomy required a significantly shorter mean hospital stay (2.1 days) and convalescence (28.0 days) than abdominal hysterectomy (4.1 days and 38.0 days, respectively). There were no significant differences in mean hospital charges between the study groups (laparoscopic $8161, abdominal $6974). CONCLUSION: Except for operating time, there are no differences between laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy regarding intraoperative characteristics among abdominal hysterectomy candidates. Postoperatively, laparoscopically assisted vaginal hysterectomy requires a shorter hospital stay and convalescence. Hospital charges are similar between the procedures. A larger number of cases will help determine the indications for laparoscopically assisted vaginal hysterectomy.

Adult↗

PubMed2003

[Uterine myomatosis--abdominal hysterectomy, vaginal hysterectomy or laparoscopic-assisted vaginal hysterectomy?].

OBJECTIVE: To evaluate the way of the surgical treatment of uterine fibroids in two 5 year long periods. In the first period (1987-1991) the operative procedures--hysterectomies--were performed usually by the classical abdominal approach. In the second period (1997-2001) the modern trend of minimal invasive surgery was applied. Through analysis of three surgical procedures used (AHY, VHY, LAVHY) the conclusions concerning the advantages, disadvantages and correct indications for the selection of hysterectomy in cases of uterine fibroids are presented. STUDY DESIGN: Retrospective study. STUDY SETTING: Department of Obstetrics and Gynecology, Medical Faculty and University Hospital, Palacký University, Olomouc. METHODS: The total of 1172 patients (604 in the first period and 568 in the second period) were operated by abdominal hysterectomy (AHY), vaginal hysterectomy (VHY) or laparoscopically assisted vaginal hysterectomy (LAVHY). The factors influencing the mode of hysterectomy (body mass, weight of uterus, parity, adnexal finding, previous surgery) were analyzed. The type of anesthesia and per and postoperation complications (blood loss, conversion of vaginal to abdominal approach, inflammatory complications and administration of antibiotics) were also evaluated. RESULTS: Each of the chosen surgical procedures has advantages and disadvantages. Abdominal hysterectomy as the most invasive procedure is indicated only in extremely unfavourable findings. The least invasive procedure is VHY, which therefore is the optimal solution for the patient. LAVHY represents the operation which combines advantages of both AHY and VHY and fulfills also the criteria for minimal invasive surgery. CONCLUSION: The choice of the optimal surgical procedure in patients with uterine fibroids depends on the complex assessment of the preoperative finding, the technical possibilities of the setting and the experience of the surgeon. The goal is to chose the safest but at the same time least invasive surgical procedure.

Female↗

PubMedDate not supplied

Endoscopic subtotal hysterectomy without colpotomy: classic intrafascial SEMM hysterectomy. A new method of hysterectomy by pelviscopy, laparotomy, per vaginam or functionally by total uterine mucosal ablation.

The CISH-technique per laparotomiam, vaginam, or pelviscopiam which sometimes may be limited to a TUMA procedure should replace classic total hysterectomy is approximately 80% of the cases. Where hysterectomy is indicated CISH and TUMA reduce the feeling of disfiguration many women feel after total hysterectomy. The uterine artery is not ligated as is routinely performed at total hysterectomy where, thereafter, the vagina is supplied by collateral branches only. Atrophic tissue in the pelvic floor results. The CISH-technique preserves the full blood supply to the lower pelvis, and this is particularly important for older patients. Perhaps this is the first step in the prophylaxis against prolapse. With TUMA not only the sexual function of the vagina remains intact but through the preservation of the genital blood supply the endocrinological function of the ovaries remains unchanged. We are at the beginning of a new era of minimal invasive operative techniques in gynecology. This new era of surgery limits itself to removing only the diseased part of the affected organ. Radical operations such as oophorectomy, salpingectomy, hysterectomy etc. are reduced to a minimum and indicated only in cases of malignant disease in these organs. Experience will show whether IVH is the least physically traumatic hysterectomy technique or not. At the present IVH is the most minimally invasive hysterectomy technique.

Catheter Ablation↗

PubMed1996

A cost analysis of endometrial ablation, abdominal hysterectomy, vaginal hysterectomy, and laparoscopic-assisted vaginal hysterectomy in the treatment of primary menorrhagia.

STUDY OBJECTIVE: To assess the cost of four procedures performed to treat primary menorrhagia. DESIGN: Retrospective analysis. Setting. A 394-bed womens' teaching hospital. PATIENTS: Eighty healthy women undergoing one of the four procedures. Interventions. The study patients were equally divided among vaginal hysterectomy (VH), total abdominal hysterectomy (TAH), laparoscopic-assisted vaginal hysterectomy (LAVH), and endometrial ablation (EA). MEASUREMENTS AND MAIN RESULTS: Endometrial ablation was associated with significantly reduced hospital costs and a shorter recovery period than the other modalities. Hospital costs were less for VH and return to work was quicker after LAVH and VH. This study did not evaluate long-term failures or complications unless they occurred within the first 2 months after the procedure. CONCLUSION: Among women who could be treated by any of these techniques, VH was significantly more cost effective for the permanent management of primary menorrhagia than LAVH and TAH. The cost efficiency of EA was clearly implied, but further studies must be completed to evaluate the long-term costs associated with treatment failures. Although physicians should not choose a procedure based exclusively on cost, the expense of a less efficient or more costly procedure may affect a hospital's competitiveness in this era of managed care.

Cost-Benefit Analysis↗

PubMed1994

A critical analysis of laparoscopic assisted vaginal hysterectomies compared with vaginal hysterectomies unassisted by laparoscopy and transabdominal hysterectomies.

The first 115 laparoscopically assisted vaginal hysterectomies (LAVH) done by our faculty surgeons were compared with 220 vaginal hysterectomies (VH) and 194 abdominal hysterectomies (AH) done in our affiliated hospitals over the same period of time. Logistic regression analysis indicates that LAVHs were done for cases that would significantly be more likely selected for AH than for VH (p less than 0.0001). Matched case control studies with 28 LAVH/VH and 34 LAVH/AH pairs and bivariate analyses demonstrated that LAVH can be accomplished with low morbidity, short lengths of stay, and little, if any, increase in operating times compared with VH and AH. The LAVH procedure can be expected to replace many AHs in the future.

Adolescent↗

PubMed1979

A prospective trail comparing hysterectomy, hysterectomy plus vaginal radium, and uterine radium plus hysterectomy in stage I endometrial carcinoma.

From 1958 to 1967, a prospective randomized trial was conducted in 189 women with stage I, group I endometrial adenocarcinoma, comparing treatment by hysterectomy alone, preoperative uterine radium followed by hysterectomy, and hysterectomy and postoperative vaginal radium. All women have been followed for a minimum of 10 years. The actual survival rate at 5 years for all patients was 94.5% and at 10 years, 92.6%, with no statistical significance among the 3 treatment groups. Ther was also no statistical significance in survival rate in relation to size of uterine or myometrial invasion. There was a statistically significant difference in survival between grade I and grade III lesions (P less than 0.01) and between grade II and grade III lesions (P less than 0.05).

Adenocarcinoma↗

PubMed1996

Comparison of Pelviscopic Classic Intrafascial Semm Hysterectomy with Total Laparoscopic Hysterectomy and Laparoscopic-Assisted Vaginal Hysterectomy

We compared 223 patients, 91 undergoing laparoscopic-assisted vaginal hysterectomy (LAVH), 82 undergoing classic intrafascial Semm hysterectomy (CISH), and 50 undergoing total laparoscopic hysterectomy (TLH) between August 1993 and August 1995. The groups were comparable in age, parity, weight, and previous abdominal surgeries. The mean estimated blood loss associated with LAVH was 1.6 times greater than that with CISH and 1.8 times greater than with TLH. The mean operating time was 174.1 minutes for CISH, 169.4 minutes for TLH, and 142.5 minutes for LAVH. The mean specimen weight was 195.4 g for CISH, 88.1 g for TLH, and 142.5 g for LAVH. The overall complication rates were 3.7%, 5.4%, and 7.7%, respectively, but no major complication occurred with CISH. We suggest that CISH is safer, more effective, and less damaging than the other procedures, and associated with lower morbidity in managing benign uterine disease.

Journal Article↗

PubMed1996

Laparoscopically assisted vaginal hysterectomy in a university hospital. Decreasing the need for abdominal hysterectomy and increasing resident experience in vaginal surgery.

OBJECTIVE: To demonstrate, in a university hospital setting, that the introduction of laparoscopically assisted vaginal hysterectomy reduced the need for abdominal hysterectomy and increased resident experience in vaginal surgery. STUDY DESIGN: All hysterectomies performed for benign gynecologic disease during one year, 1993-1994, at the Medical University of South Carolina Hospital, Charleston, after introduction of laparoscopically assisted vaginal hysterectomy were compared to those performed in preceding years, 1990-1993. RESULTS: Prior to 1993, > 70% of hysterectomies at the Medical University of South Carolina Hospital were performed abdominally. With the introduction of laparoscopically assisted vaginal hysterectomy, from a total of 155 hysterectomies performed in 1993-1994, the percentage of hysterectomies performed abdominally decreased to 39 without affecting the overall percentage of traditional vaginal hysterectomies, 29. Since laparoscopic hysterectomies were completed with a significant vaginal component to the operation, the actual resident experience with vaginal hysterectomy increased to 61% of hysterectomies. Straightforward vaginal hysterectomies were performed on patients with higher parity and traditional indications, such as cervical intraepithelial neoplasia and prolapse. Patients who underwent laparoscopically assisted vaginal hysterectomy were not considered candidates for traditional vaginal hysterectomy and had significantly fewer complications and hospital days but did have significantly smaller uteri and greater hospital charges than did patients who underwent abdominal hysterectomy (P < .05). No significant difference was found for length of operating time or blood loss between each method of hysterectomy. CONCLUSION: Laparoscopically assisted vaginal hysterectomy, when used as an alternative to abdominal hysterectomy in patients not considered candidates for vaginal hysterectomy, decreased the need for abdominal hysterectomy, with fewer complications, and shorter hospital stay and increased resident experience with vaginal surgery.

Adult↗

PubMed2004

The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy.

OBJECTIVE: To compare the effects of laparoscopic hysterectomy and abdominal hysterectomy in the abdominal trial, and laparoscopic hysterectomy and vaginal hysterectomy in the vaginal trial. DESIGN: Two parallel, multicentre, randomised trials. SETTING: 28 UK centres and two South African centres. PARTICIPANTS: 1380 women were recruited; 1346 had surgery; 937 were followed up at one year. Primary outcome Rate of major complications. RESULTS: In the abdominal trial laparoscopic hysterectomy was associated with a higher rate of major complications than abdominal hysterectomy (11.1% v 6.2%, P = 0.02; difference 4.9%, 95% confidence interval 0.9% to 9.1%) and the number needed to treat to harm was 20. Laparoscopic hysterectomy also took longer to perform (84 minutes v 50 minutes) but was less painful (visual analogue scale 3.51 v 3.88, P = 0.01) and resulted in a shorter stay in hospital after the operation (3 days v 4 days). Six weeks after the operation, laparoscopic hysterectomy was associated with less pain and better quality of life than abdominal hysterectomy (SF-12, body image scale, and sexual activity questionnaires). In the vaginal trial we found no evidence of a difference in major complication rates between laparoscopic hysterectomy and vaginal hysterectomy (9.8% v 9.5%, P = 0.92; difference 0.3%, -5.2% to 5.8%), and the number needed to treat to harm was 333. We found no evidence of other differences between laparoscopic hysterectomy and vaginal hysterectomy except that laparoscopic hysterectomy took longer to perform (72 minutes v 39 minutes) and was associated with a higher rate of detecting unexpected pathology (16.4% v 4.8%, P = < 0.01). However, this trial was underpowered. CONCLUSIONS: Laparoscopic hysterectomy was associated with a significantly higher rate of major complications than abdominal hysterectomy. It also took longer to perform but was associated with less pain, quicker recovery, and better short term quality of life. The trial comparing vaginal hysterectomy with laparoscopic hysterectomy was underpowered and is inconclusive on the rate of major complications; however, vaginal hysterectomy took less time.

Adult↗

PubMed1999

Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: a prospective, randomized, multicenter study.

OBJECTIVE: The objective of this study was to evaluate short-term results of laparoscopically assisted vaginal hysterectomy with those of total abdominal hysterectomy in a prospective, randomized, multicenter study. STUDY DESIGN: One hundred sixteen patients referred for abdominal hysterectomy were randomized to either laparoscopically assisted vaginal hysterectomy (58 patients) or abdominal hysterectomy (58 patients). Inclusion criteria were one or more of the following, where a vaginal hysterectomy would be traditionally contraindicated: uterine size larger than 280 g, previous pelvic surgery, history of pelvic inflammatory disease, moderate or severe endometriosis, concomitant adnexal masses or indication for adnexectomy, and nulliparity with lack of uterine descent and limited vaginal access. An upper limit of uterine size was set at 16 weeks' gestation (ie, 700 g). RESULTS: There were no differences in terms of patient's age, parity, preoperative hemoglobin levels, mean uterine weight, and total operating time between the 2 groups. Estimated blood losses and postoperative day 1 hemoglobin drop were significantly lower for laparoscopically assisted vaginal hysterectomy than for abdominal hysterectomy (P<.05). There were 1 major and 2 minor complications in the laparoscopically assisted vaginal hysterectomy group compared with 2 major and 5 minor complications in the abdominal hysterectomy group (P not significant). Postoperative pain was lower for laparoscopically assisted vaginal hysterectomy than for abdominal hysterectomy on postoperative days 1, 2, and 3 (P<.05). Postoperative hospital stay was significantly shorter for laparoscopically assisted vaginal hysterectomy than for abdominal hysterectomy (P<.001). CONCLUSIONS: The present study demonstrates that, given adequate training in laparoscopic surgery, laparoscopically assisted vaginal hysterectomy may replace abdominal hysterectomy in most patients who require a hysterectomy and have contraindications to vaginal hysterectomy, with all the benefits associated with the vaginal route.

Adult↗

PubMed2004

Comparison of laparoscopic-assisted vaginal hysterectomy with traditional hysterectomy for cost-effectiveness to employers.

OBJECTIVE: The purpose of this study was to compare the cost-effectiveness of laparoscopic-assisted vaginal hysterectomy to traditional total abdominal hysterectomy and total vaginal hysterectomy with regard not only to direct hospital costs but also to indirect costs. STUDY DESIGN: This was a combined retrospective cohort study (Canadian Task Force classification II-2) that was conducted in a suburban private practice. The cases of 268 patients who underwent hysterectomies over a 27-month period were analyzed to include clinical outcomes, direct hospital costs, and indirect costs (time to return to normal function, time to return to work, and time away from work required by other family members). RESULTS: For all patients, length of hospital stay and time of return to normal function were shorter for laparoscopic-assisted vaginal hysterectomy than for total abdominal hysterectomy and total vaginal hysterectomy. For working patients, time to return to work and time off for working family members were all significantly shorter after laparoscopic-assisted vaginal hysterectomy when compared with both total abdominal hysterectomy and total vaginal hysterectomy. Operating times were similar for total abdominal hysterectomy and laparoscopic-assisted vaginal hysterectomy, and complications were greater for total abdominal hysterectomy. In a comparison of all procedures, direct hospital costs were greatest for laparoscopic-assisted vaginal hysterectomy and least for total vaginal hysterectomy. CONCLUSION: For most patients, laparoscopic-assisted vaginal hysterectomy provides a minimally invasive way to accomplish a hysterectomy with a lower cost to employers (payers) on the basis of lost work hours.

Adult↗

PubMed1993

Laparoscopically assisted vaginal hysterectomy in a university hospital: report of 82 cases and comparison with abdominal and vaginal hysterectomy.

OBJECTIVE: The objective of this study was to critically review the indications, outcomes, complications, and costs of laparoscopically assisted vaginal hysterectomy in comparison with abdominal and vaginal hysterectomy. STUDY DESIGN: The operating room log was reviewed to determine the number and route of hysterectomies performed over a 1-year period. The charts of 50 consecutive laparoscopically assisted vaginal hysterectomies and 50 vaginal hysterectomies were reviewed. Charts from 50 selected abdominal hysterectomies were also reviewed. Information on patient characteristics, indications, complications, uterine weights, hospital stay, and patient costs were obtained and analyzed. RESULTS: Of 509 hysterectomies, 82 were performed as laparoscopically assisted vaginal hysterectomies and 73 as vaginal hysterectomies. The patient characteristics and indications of the laparoscopically assisted group more closely matched those of the abdominal hysterectomy group. The complication rate in the laparoscopically assisted group was intermediate between the other two groups, but the hospital stay was significantly less. Patient cost for laparoscopically assisted vaginal hysterectomy was significantly greater than either abdominal or vaginal hysterectomy, in spite of the shortened hospital stay. CONCLUSIONS: Laparoscopically assisted vaginal hysterectomy offers a technique to convert some abdominal hysterectomies into vaginal hysterectomies. It appears particularly useful when an adnexal indication for surgery exists. Uterine leiomyoma does not appear to be an indication for laparoscopically assisted vaginal hysterectomy. The costs are significant because of increased operating time and costs of disposable equipment.

Abdomen↗

PubMed1994

Changing hysterectomy patterns after introduction of laparoscopically assisted vaginal hysterectomy.

OBJECTIVE: The objective of this study was to determine whether introduction of laparoscopically assisted vaginal hysterectomy decreases the percentage of women requiring laparotomy for hysterectomy. STUDY DESIGN: A retrospective review of women undergoing hysterectomies from 1990 through 1992 was performed. Type of hysterectomy and total hospital charges were determined. Indication for surgery and complications in the laparoscopically assisted vaginal hysterectomy group were also examined. RESULTS: During the study interval 670 hysterectomies were performed. In 1990 and 1991 abdominal hysterectomies comprised 51.5% and 45.5% of all hysterectomies, respectively. After introduction of laparoscopically assisted vaginal hysterectomy in 1992 the percentage of abdominal hysterectomies declined to 35.6%, whereas the percentage of unassisted vaginal hysterectomies remained stable. The complication rate for patients with laparoscopically assisted vaginal hysterectomy was 16%. Average cost was $11,931 compared with $7031 for abdominal hysterectomy and $5343 for vaginal hysterectomy. CONCLUSION: Laparoscopically assisted vaginal hysterectomy can decrease the number of patients requiring a laparotomy for hysterectomy but at a much greater cost.

Adult↗

PubMed1997

Complications and recovery from laparoscopy-assisted vaginal hysterectomy compared with abdominal and vaginal hysterectomy.

OBJECTIVE: To complete a systematic review of the published literature comparing complications, postoperative recovery time, and costs following laparoscopy-assisted vaginal hysterectomy, total abdominal hysterectomy (TAH), and vaginal hysterectomy. DATA SOURCES: We searched MEDLINE and several bibliographies, identifying all reports using the term "laparoscopy-assisted hysterectomy" published from 1989 to September 1995. METHODS OF STUDY SELECTION: We excluded case reports, letters, and reports of laparoscopy-assisted vaginal hysterectomy procedures used for radical cancer surgery, sex-change operations, total laparoscopic hysterectomy, or supracervical hysterectomy. TABULATION, INTEGRATION, AND RESULTS: Cases identified included 3112 laparoscopy-assisted vaginal hysterectomies, 1618 TAHs, and 690 vaginal hysterectomies. Laparoscopy-assisted vaginal hysterectomy cases compared with TAH cases demonstrated significantly greater incidence of bladder injury (1.8% for laparoscopy-assisted vaginal hysterectomy versus 0.4% for TAH; P = .01), significantly longer operating room time (115 minutes, standard deviation [SD] 37 minutes, for laparoscopy-assisted vaginal hysterectomy versus 87 minutes, SD 18 minutes, for TAH; P < .001), and significantly shorter hospitalization (49 hours, SD 16 hours, for laparoscopy-assisted vaginal hysterectomy versus 79 hours, SD 20 hours, for TAH; P < .001). Use of analgesia was consistently less for laparoscopy-assisted vaginal hysterectomy and return to full activity was always sooner when compared to TAH. Cost for the new procedure was higher in seven out of 11 studies, but when disposable instruments and hospital length of stay are considered, the remaining four studies reported a lower cost for laparoscopy-assisted vaginal hysterectomy. CONCLUSION: Although laparoscopy-assisted vaginal hysterectomy involves a shorter hospital stay, speedier postoperative recovery, and less analgesia use, there is also a higher rate of bladder injury and lengthier surgery. These outcomes must be weighed when choosing an intervention.

Female↗

PubMed1995

Laparoscopic hysterectomy compared with abdominal and vaginal hysterectomy in a community hospital.

STUDY OBJECTIVE: To compare costs of laparoscopic hysterectomy with those of abdominal and vaginal hysterectomies in a community hospital. DESIGN: Retrospective review. Study cases were controlled for severity of pathology and extent of surgery performed laparoscopically. Charges were corrected for inflation. SETTING: Rural community hospital, fee for service practice. PARTICIPANTS: Women undergoing hysterectomy during the study period. INTERVENTIONS: Hysterectomy performed with or without laparoscopy. MEASUREMENTS AND MAIN RESULTS: Operating times, operating room charges, total hospital charges, uterine weight, length of hospital stay, and complications were tabulated for laparoscopic, abdominal, and vaginal hysterectomies, with and without bilateral salpingo-oophorectomy. The use of a video monitor and disposable instruments was associated with increased costs and longer operating times. With reusable instruments and a simple operating technique performed while looking down an operating laparoscope, laparoscopic hysterectomy was less costly than abdominal hysterectomy. Laparoscopy without treatment of concurrent pathology before vaginal hysterectomy was associated with increased costs. Vaginal hysterectomy was faster and less expensive than any other form of hysterectomy. Some abdominal hysterectomies could possibly have been performed vaginally. There was no advantage in studying patients undergoing hysterectomy with bilateral salpingo-oophorectomy separately from those undergoing hysterectomy alone. Complications were similar in all groups. CONCLUSIONS: Laparoscopic hysterectomy performed with a simple electrosurgical technique and reusable instruments, and without a video monitor was less expensive than abdominal hysterectomy. The video control and disposable instruments were associated with longer operating times and higher charges.

Disposable Equipment↗

PubMed1993

A comparison of laparoscopically assisted vaginal hysterectomy vs traditional total abdominal and vaginal hysterectomies.

The objective of this work was to compare laparoscopically assisted vaginal hysterectomy to traditional total abdominal and vaginal hysterectomies in seven critical areas: anesthesia time, surgery time, hospital stay, operative blood loss, total analgesic use, time required to return to work, and total cost of each of these procedures. The first 25 unscreened, consecutive laparoscopically assisted vaginal hysterectomies performed by the senior author were compared with 25 randomly selected traditional total abdominal and 25 randomly selected vaginal hysterectomies performed by the senior author's professional corporation. Laparoscopically assisted vaginal hysterectomy compared favorably to abdominal and vaginal hysterectomy in three areas and was superior to both total abdominal hysterectomy and vaginal hysterectomy in the remaining four areas. Although the use of the endoscopic stapling device and laser made the laparoscopically assisted vaginal hysterectomy a more expensive procedure than traditional vaginal hysterectomy, the expense was not significant and was justified by the decreased surgery time. The results of this comparative study suggest that laparoscopically assisted vaginal hysterectomy is superior or comparable to total abdominal hysterectomy and vaginal hysterectomy, especially for patients who may not have been candidates for vaginal hysterectomy. This procedure has allowed the gynecologic endoscopic surgeon to convert abdominal to vaginal procedures. Laparoscopically assisted vaginal hysterectomy provides an overall cost savings to the patient, has a low complication rate, adapts well to the outpatient setting, causes less patient discomfort, and allows the patient to return rapidly to home and workplace.

Adult↗

PubMed1992

Randomized comparison of laparoscopy-assisted vaginal hysterectomy with standard vaginal hysterectomy in an outpatient setting.

OBJECTIVE: To compare outpatient laparoscopy-assisted vaginal hysterectomy with standard outpatient vaginal hysterectomy. METHODS: Fifty-six women scheduled for vaginal hysterectomy were randomly assigned to undergo either a laparoscopy-assisted vaginal hysterectomy with endoscopic staples (N = 29) or a standard vaginal hysterectomy (N = 27). There were no differences between the study groups with regard to age, gravidity, parity, preoperative indications, and previous operations. RESULTS: Twenty-eight of 29 laparoscopy-assisted vaginal hysterectomies and all 27 vaginal hysterectomies were completed without incident. When indicated, unilateral or bilateral oophorectomies were completed. The mean operating time was significantly longer for laparoscopy-assisted vaginal hysterectomy (120.1 versus 64.7 minutes). Fifty-three of the 55 patients completing surgery were discharged home by 12 hours from the time of admission. Complications with laparoscopic hysterectomy were related to the technical aspects of laparoscopy. The incidence of febrile morbidity was similar in the groups. Although patients having laparoscopy-assisted hysterectomy required statistically significantly more pain medication and had lower postoperative hematocrit measurements, this did not make a clinical difference in the postoperative courses. The mean hospital charge for laparoscopy-assisted vaginal hysterectomy was $7905 and for vaginal hysterectomy $4891. CONCLUSION: Other than cost, laparoscopy-assisted vaginal hysterectomy and standard vaginal hysterectomy appear comparable in patients who could otherwise undergo a vaginal hysterectomy.

Adult↗