Abstract
The objective of this study was to compare surgical outcomes for laparoscopically assisted vaginal hysterectomy (LAVH) with total laparoscopic hysterectomy (TLH) in three teaching hospitals in the Netherlands. This study is a multicenter cohort retrospective analysis of consecutive cases (Canadian Task Force classification II-2). One hundred and four women underwent a laparoscopic hysterectomy between March 1995 and March 2005 at one of three teaching hospitals. This included 37 women who underwent LAVH and 67 who underwent TLH. Blood loss, operating time, and intraoperative complications such as bladder or ureteric injury as well as conversion to an open procedure were recorded. In the TLH group, average age was statistically significant lower, as well as the mean parity, whereas estimated uterus size was statistically significant larger, compared to the LAVH group. Main indication in both groups was dysfunctional uterine bleeding. In the TLH group, mean blood loss (173 mL) was significant lower compared to the LAVH group (457 mL), whereas length of surgery, uterus weight, and complication rates were comparable between the two groups. The method of choice at the start of the study period was LAVH, and by the end of the study period, it had been superceded by TLH. LAVH should not be regarded as the novice’s laparoscopic hysterectomy. Moreover, with regard blood loss, TLH shows advantages above LAVH. This might be due to the influence of the altered anatomy in the vaginal stage of the LAVH procedure. Therefore, when a vaginal hysterectomy is contraindicated, TLH is the procedure of choice. LAVH remains indicated in case of vaginal hysterectomy with accompanying adnexal surgery.
Highlights
Hysterectomy is the most frequently performed major gynecologic surgical procedure annually throughout the world [1]
Women in the total laparoscopic hysterectomy (TLH) group were statistically significant younger and had a lower parity compared to the women in the laparoscopic-assisted vaginal hysterectomy (LAVH) group (Table 2)
It must be considered that participating surgeons during this study period were still in their learning curve
Summary
Hysterectomy is the most frequently performed major gynecologic surgical procedure annually throughout the world [1]. The most common indication for hysterectomy is uterine fibroids, followed by dysfunctional uterine bleeding [2]. Abdominal hysterectomy (AH) has been used for Gynecological malignancy or if the uterus is enlarged. Vaginal hysterectomy (VH) was originally used only for prolapse, but it is used for dysfunctional uterine bleeding when the uterus is of fairly normal size [3]. Laparoscopic hysterectomy (LH) was introduced in 1988 and published in 1989 by Harry Reich as an alternative to Gynecol Surg (2009) 6:311–316 abdominal hysterectomy. In the 1990s, most gynecologists “adopted” the alternative laparoscopic-assisted vaginal hysterectomy (LAVH), an operation in which the upper blood supply to the uterus was ligated laparoscopically followed by a vaginal hysterectomy. Laparoscopic hysterectomy in general requires other technical skills than the vaginal or abdominal method [5]
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