Comparison of Laparoscopically Assisted Vaginal Hysterectomy and Abdominal Hysterectomy: A Randomized Controlled Trial

Abstract

Objective To compare intraoperative hemorrhage and other operative parameters after laparoscopically assisted vaginal hysterectomy (LAVH) versus total abdominal hysterectomy (TAH) for benign gynecologic conditions. Design A prospective, randomized, controlled trial. Materials and Methods Between April 2010 and March 2011, 50 Thai patients with strong indications for hysterectomy—with uterine sizes ≤16 weeks of gravid uterus and with no contraindications for open or laparoscopic surgeries—were randomly assigned for LAVH or TAH. Main Outcome Measures Intraoperative blood loss, operating time, postoperative analgesic requirements, perioperative complications, and duration of hospitalization. Results Intraoperative blood loss was significantly less in the LAVH group (median 120 mL [range 50–300]) than in the TAH group (median 250 mL [105–800]) (median difference 130 mL, p <.001, 95% confidence interval [CI] 55–200). The LAVH group required significantly less postoperative morphine sulfate administration (median 3 mg [range 0–12]) than the TAH group (15 mg [6–24]) (median difference 9 mg, p <.001, 95% CI 9–12). The hospital stay for the LAVH group (median 3 days; range 2–7) was significantly shorter than that of the TAH group (median 4 days; range 4–5) (median difference 2 days, p <.001, 95% CI 1–2). The operating time was comparable between the 2 groups (median 100 minutes; range 50–240) for the LAVH and 115 minutes (range 60–200) for the TAH group (median difference 5 minutes, p =.592, 95% CI −15–25). There were no conversions from a LAVH to a laparotomy. Conclusions The LAVH has advantages over the TAH in that in the former there is less intraoperative blood loss, less postoperative morphine requirement, and a shorter duration of postoperative hospital stays.