Patient selection and surgical technique may reduce major complications of laparoscopic-assisted vaginal hysterectomy

Abstract

Study objective To study the clinical outcome of patients who underwent laparoscopic-assisted vaginal hysterectomy especially with regard to early postoperative complications. Design Retrospective study (Canadian Task Force classification II-3). Setting Private hospital in Hamilton, New Zealand. Patients Four hundred eighteen women. Intervention Laparoscopic-assisted vaginal hysterectomy. Measurements and main results Primary indication for surgery, operating time, hospital stay, and major complications were analyzed. Major complications were defined as life-threatening injuries, unintended major surgical procedures, and conversions to laparotomy that occurred under duress (eg, intraoperative hemorrhage). Complications were reported up to 6 weeks of postoperative time. The total early postoperative complication rate was 11.24%. No patient had damage to the bowel, ureter, or bladder. There were no deaths. Major complications were three cases of partial vault dehiscence and one case of partial small bowel obstruction. The operation was performed successfully in 412 cases. Six patients needed laparotomy. Conclusions This retrospective study shows that laparoscopic-assisted vaginal hysterectomy is a safe surgical procedure. The possible reasons for the low complication rate reported are the surgical technique of ureteral dissection, the use of suitable instruments to expose the vaginal fornices, a consistent team approach, and the selection of patients.