Laparoscopic assisted vaginal hysterectomy at the clinic of gynecology and obstetrics in Novi Sad

Abstract

Introduction. Laparoscopic assisted vaginal hysterectomy is a surgical procedure with uterine artery ligation followed by vaginal removal of the uterus. The first laparoscopic assisted vaginal hysterectomy was performed by Harry Reich in 1989. Material and Methods. The sample included 24 patients who underwent surgery at the Clinic of Gynecology and Obstetrics, Clinical Center of Vojvodina in Novi Sad in the period 2014 - 2017. The most common indications for laparoscopic assisted vaginal hysterectomy included mild uterine prolapse and uterine fibroids (15 patients, 62.5%). The surgery was carried out in two stages: the first, laparoscopic stage and the second, vaginal stage. The laparoscopic stage included mobilization of the bladder, ovaries and uterus to the level of uterine vessels. In the second stage, the cervix was approached vaginally and detached from the urinary bladder, after which the uterus with cervix and adnexa were removed through the vagina. Results. The average age of patients was 56.8 years; on average, the surgeries lasted 140 minutes and the mean blood loss was 190 ml. Two (8.3%) patients experienced bladder and ureteral injuries which were resolved by urologists. Laparoscopic assisted vaginal hysterectomy was the only procedure performed in 5 (20.8%) patients, whereas it was combined with anterior and/or posterior colporrhaphy in 14 (58.4%), with pelvic lymphadenectomy in 3 (12.5%) patients, and with uterine morcellation in 2 (8.3%) patients. Conclusion. There are no published controlled trials related to the use of laparoscopic assisted vaginal hysterectomy and total laparoscopic hysterectomy in Serbia. This paper presents the preliminary results of the laparoscopic assisted vaginal hysterectomy in 24 patients, comparing them with other techniques of hysterectomy conducted at the Clinic of Gynecology and Obstetrics, Clinical Center of Vojvodina in Novi Sad in the period 2014 - 2017. Laparoscopic assisted vaginal hysterectomy is a good option for surgical treatment of patient with combined pathology of genital organs.