Total Abdominal Hysterectomy Group Research Articles

Lower urinary tract symptoms after total and subtotal hysterectomy: results of a randomized controlled trial

The aim of this Danish multicenter trial was to compare the proportion of women with lower urinary tract symptoms after total abdominal hysterectomy (TAH) and subtotal abdominal hysterectomy (SAH) for benign uterine disorders. A total of 319 women were randomized to TAH (n = 158) or SAH (n = 161). Women were followed up for 1 year by strict data collection procedures, including postal questionnaires. Results were analyzed by intention-to-treat analyses. Urinary incontinence was found less often among TAH women than among SAH women. This was due to a larger reduction of the number of women with stress and urinary incontinence in the TAH group. No other differences were found between the two operation methods. The number of women with urinary incontinence and frequency was reduced from study entry for follow-up, while double/triple voiding was increased. Incontinent women had significantly lower quality of life scores than continent women

A comparison of laparoscopic supracervical hysterectomy and total abdominal hysterectomy outcomes

To compare operative and postoperative results of laparoscopic supracervical hysterectomy (LSH) and total abdominal hysterectomy (TAH). Cohort retrospective analysis of consecutive patients (Canadian Task Force classification II-3). Department of gynecology at a metropolitan medical center. Two hundred-twenty women who underwent LSH with or without bilateral salpingo-oophorectomy (BSO). Two hundred-twenty women who underwent TAH with or without BSO. Both groups had similar surgical indications and final pathology. Women who underwent LSH had a shorter operating time than those in the TAH group (47.7 +/- 14.6 min vs 74.9 +/- 25.6 min). Hospital stay was significantly shorter in the LSH group, and those patients returned to work sooner. The operative complication rate was higher in the TAH group (2.7% vs 0.9%). Postoperative complication rate for the TAH group was higher than the LSH group (25% vs zero). Laparoscopic supracervical hysterectomy is a safe and effective surgical treatment for patients in need of a hysterectomy with or without BSO. The procedure can be performed in an outpatient setting. Patients experience a much quicker recovery than those who undergo TAH, and the complication rate is significantly lower.

Total laparoscopic hysterectomy versus total abdominal hysterectomy for obese women with endometrial cancer

Obesity is common in endometrial cancer and surgery for these patients is challenging. We compared total laparoscopic hysterectomy (TLH) with total abdominal hysterectomy (TAH) with respect to feasibility (operating time, estimated blood loss, length of hospital stay, and conversion to laparotomy) and safety (perioperative morbidity and mortality) in a retrospective analysis of 78 morbidly obese patients with endometrial cancer. Analysis is based on the intention to treat. The intention to treat was TLH in 47 patients and it could be successfully completed in 42 patients (89.4%). The mean weight for all patients was 118.7 kg, with patients in the TLH group weighing more and having higher ASA scores. Mean operating time and estimated blood loss were similar in both groups. Mean postoperative hospital stay was 4.4 (+/-3.9) days in the TLH group and 7.9 (+/-3.0) days in the TAH group (P < 0.0001). Wound infections occurred in 15 of 31 patients (48.4%) in the TAH group and in 1 of 47 patients (2.1%) in the TLH group. All other morbidity, as well as patterns of recurrence and survival were similar in both groups. These data justify a prospective randomized trial comparing TLH with TAH for the treatment of endometrial cancer.

Total laparoscopic hysterectomy versus total abdominal hysterectomy for obese women with endometrial cancer

Obesity is common in endometrial cancer and surgery for these patients is challenging. We compared total laparoscopic hysterectomy (TLH) with total abdominal hysterectomy (TAH) with respect to feasibility (operating time, estimated blood loss, length of hospital stay, and conversion to laparotomy) and safety (perioperative morbidity and mortality) in a retrospective analysis of 78 morbidly obese patients with endometrial cancer. Analysis is based on the intention to treat. The intention to treat was TLH in 47 patients and it could be successfully completed in 42 patients (89.4%). The mean weight for all patients was 118.7 kg, with patients in the TLH group weighing more and having higher ASA scores. Mean operating time and estimated blood loss were similar in both groups. Mean postoperative hospital stay was 4.4 (±3.9) days in the TLH group and 7.9 (±3.0) days in the TAH group (P &lt; 0.0001). Wound infections occurred in 15 of 31 patients (48.4%) in the TAH group and in 1 of 47 patients (2.1%) in the TLH group. All other morbidity, as well as patterns of recurrence and survival were similar in both groups. These data justify a prospective randomized trial comparing TLH with TAH for the treatment of endometrial cancer

Laparoscopic hysterectomy: The Kaiser Permanente San Diego experience

To evaluate patient and surgical characteristics of laparoscopic hysterectomy (LH), including both total laparoscopic hysterectomy (TLH) and laparoscopic supracervical hysterectomy (LSH), compared with total abdominal hysterectomy (TAH). Retrospective, comparative study (Canadian Task Force classification II-2). Health maintenance organization/residency-training program. One hundred eight patients who underwent TLH, 251 patients who underwent LSH, and 255 patients who underwent TAH. There was no randomized controlled system to assign patients to the three types of hysterectomy. Patients with ancillary procedures were excluded from all three groups. The study period included February 2000 through September 2002. Hysterectomy. Analysis of covariance revealed that laparoscopic procedures require significantly more time to complete than TAH. Adjusted differences were 46.4 minutes longer for TLH (p <.0001) and 38.3 minutes longer for LSH (p <.0001). The adjusted estimated blood loss was 91.0 mL less with TLH (p <.0001) and 72.6 mL less with LSH (p < .0001) than with TAH. The hospital lengths of stay were significantly shorter for LH compared with TAH. The adjusted differences were 41.7 hours less with TLH (p <.0001) and 45.1 hours less with LSH (p <.0001). Rates of major complications were 5.6% with TLH, 0.8% with LSH, and 8.2% with TAH. Rates of minor complications were 17.6% with TLH, 16.7% with LSH, and 14.1% with TAH. Rates of any complication were 21.3% with TLH, 17.1% with LSH, and 20.8% with TAH. (Note: some patients in each group had both a minor and a major complication, so that minor and major complications do not exactly add up to "any complication.") The readmission rates for TLH, LSH, and TAH were 5.6%, 1.2%, and 2.0%, respectively. Same-day discharge for TLH and LSH occurred in 16.7% and 25.1% of patients, respectively. The variables indicating minor complications, any complications, wound infections, urinary tract infections, readmissions, and same-day discharges (in the laparoscopic groups) were not differentiated by surgery type. Major complications were differentiated by procedure class; namely, total hysterectomy (TLH and TAH) had significantly more major complications than LSH (adjusted p = .001). Wound abscesses (16 patients) occurred only in the TAH group (adjusted p <.0001). Pelvic cellulitis (17 patients) occurred in all surgical groups, but was more likely to occur in the LH groups (adjusted p = .01). Laparoscopic hysterectomy, both total and supracervical, can be successfully integrated into a large health maintenance organization/residency-training program. Laparoscopic hysterectomy took significantly longer to perform than TAH in this new program. Estimated blood loss was significantly less with LH than with TAH. Hospital length of stay was significantly less with LH than TAH. Major complications with TLH, minor complications with LH, overall complications, wound infections, urinary tract infections, and readmissions appear comparable with these parameters in TAH within the limits of our study size and design. Pelvic cellulitis was significantly more common with LH, and wound abscess was significantly more common with TAH. Major complications were significantly less common with LSH compared with combined TLH and TAH. Same-day discharge after LH seems to be an attractive option worth developing further. Our patients have enthusiastically accepted these new minimally invasive techniques for performing hysterectomy. We anticipate continued expansion of our LH program.

A Randomized Comparison of Total or Supracervical Hysterectomy: Surgical Complications and Clinical Outcomes

The Total or Supracervical Hysterectomy Research Group (TOSH) presents a comparison of total versus supracervical hysterectomy in 135 women from 4 different institutions. All participants were premenopausal women over 30 years of age who were planning abdominal hysterectomy for symptomatic uterine leiomyomata, abnormal uterine bleeding, or both. Women with abnormal cervical cytology or suspected malignancy were not included. Patients were randomized to undergo standard total abdominal hysterectomy (TAH) or supracervical hysterectomy (SCH) performed using the operating surgeon's customary technique. At the initial visit and every 3 months for 2 years, participants provided information on gynecologic and reproductive history, gynecologic symptoms, including bleeding, pain, pelvic or bladder pressure, low back pain, and urinary incontinence, and also quality-of-life measures. There were 67 women in the TAH group and 68 in the SCH group. Both groups were similar in clinical and demographic characteristics. Intraoperative decisions converted 3 women in the TAH group to SCH and 4 in the SCH to TAH. In addition, 2 women in the TAH group and 1 in the SCH group did not have a hysterectomy. Histopathologic examination of the surgical specimen found complex hyperplasia of the endometrium with atypia in 2 patients in the SCH group. In the TAH group, 3 patients had high-grade squamous intraepithelial lesions of the cervix and 1 had a uterine sarcoma found adjacent to a submucous leiomyomata and an adenomyosis implant. No differences were seen between the 2 groups in surgical characteristics, clinical findings, or complications. In each group, there was one death unrelated to hysterectomy. Twenty-one women in the SCH group were readmitted to the hospital a total of 29 times. Eight of these women had 10 readmissions, which were related to hysterectomy. In the TAH group, 15 patients had a total of 11 readmissions, 5 of which were related to hysterectomy in 4 patients. This difference between the 2 groups was not significant. Multivariable analysis of all factors affecting readmission found that baseline weight (before surgery) greater than 100 kg more than doubled the risk of being readmitted to the hospital for all causes (relative risk [RR], 2.18; 95% confidence interval [CI], 1.6-4.48; P = 0.034). There was a nonsignificant increased risk for readmission related to hysterectomy (RR, 2.83; 95% CI, 0.86-9.36; P = 0.088). Baseline weight greater than 100 kg was the only significant predictor for hospital readmission. After 24 months of follow up, women in both the TAH and the SCH group reported a 48% to 97% reduction in pelvic symptoms and back pain. Urinary tract symptoms and incontinence were similarly reduced, 41% to 88% in both groups. The 2 groups were similar in their use of postoperative narcotic analgesic, infection rate, pelvic pain, and reports of depression. The number of days of work missed, days spent in bed, and days of reduced activity were similar for both groups.

Randomised controlled trial of total compared with subtotal hysterectomy with one‐year follow up results

To compare total abdominal hysterectomy and subtotal abdominal hysterectomy performed for benign uterine diseases. Randomised, controlled, unblinded trial with central, computer-generated randomisation. Danish trial performed in 11 departments of gynaecology. Women referred for benign uterine diseases were randomised to total abdominal hysterectomy (n = 158) or subtotal abdominal hysterectomy (n = 161). One-year follow up questionnaires had a response rate of 87%. Patients were followed by strict data collection procedures, including postal questionnaires. The results after one year of follow up were analysed by intention-to-treat analyses. (1) Primary: urinary incontinence and (2) secondary: post-operative complications, quality of life (SF-36), constipation, prolapse of the vaginal vault/cervical stump, satisfaction with sexual life, pelvic pain and vaginal bleeding. A significantly (P = 0.043) smaller proportion of women had urinary incontinence one year after total abdominal hysterectomy compared with subtotal abdominal hysterectomy [9% vs 18% (OR 2.08, 95% CI 1.01-4.29)]. The lower proportion of incontinent women in the total abdominal hysterectomy group was a result of a higher proportion of symptom relief (total abdominal hysterectomy: 20/140, subtotal abdominal hysterectomy: 14/136) as well as a lower proportion of women with new symptoms (total abdominal hysterectomy: 3/140, subtotal abdominal hysterectomy: 10/137). Twenty-seven women (20%) from the subtotal abdominal hysterectomy group had vaginal bleeding and two of them had to have their cervix removed. No other clinically important differences were found between the two hysterectomy methods. A smaller proportion of women suffered from urinary incontinence after total abdominal hysterectomy than after subtotal abdominal hysterectomy one year post-operatively.

Laparoscopically Assisted Vaginal Hysterectomy versus Total Abdominal Hysterectomy: A Study of 100 Cases on Light-Endorsed Transvaginal Section

The objective of this study was to compare the results of a modified laparoscopically assisted vaginal hysterectomy (LAVH) procedure, using light-endorsed transvaginal section by two puncture trocars, with those of total abdominal hysterectomy (TAH) in a prospective, randomized, short-term study. A new, modified LAVH technique using Endo GIA stapler and two puncture trocars was established. For the laparoscopic phase, each adnexum was dissected, and the vesicouterine junction was identified clearly with the laparoscopic light from the vaginal side. Vaginal-phase surgery was performed as usual. Two hundred patients scheduled for abdominal hysterectomy were randomized to either LAVH (n = 100) or TAH (n = 100). Duration of hospitalization, time of surgery, dose of analgesics, and rates of complications were significantly lower in the LAVH group (p < 0.001). The average operating time was 77 ± 30 min for LAVH and 102 ± 18 min for TAH. The duration of hospitalization was 3.2 ± 0.7 days for LAVH and 5.5 ± 1.3 days for TAH. There were three complications in the LAVH group and 15 in the TAH group. Postoperative meperidine requirements (1.2 vs. 3.7 ampoules, 1 ampoule = 50 mg) were significantly fewer in the LAVH group. Regarding the training time, the mean operating time in the first 20 cases was 98 min, and in the last 20 cases it was 70.9 min. As compared with TAH and other modified LAVH procedures reported previously, the present technique is easy to learn and timesaving with fewer complications.

Cost analysis of myomectomy, hysterectomy, and uterine artery embolization

Objective: The purpose of this study was to compare inpatient hospital costs of different treatments of uterine fibroid tumors, including myomectomy, hysterectomy, and uterine artery embolization in a teaching hospital. Study Design: We reviewed the hospital database of 545 women with uterine fibroid tumors who were treated with abdominal myomectomy, total abdominal hysterectomy, vaginal hysterectomy, and uterine artery embolization between April 1997 and October 2001. Results: Women who underwent hysterectomies and uterine artery embolization were significantly older than the women who underwent myomectomy. Uterine artery embolization was associated with the shortest hospital stay, although the hospital stay in the vaginal hysterectomy group was shorter than in the abdominal myomectomy and the total abdominal hysterectomy groups. Compared with other groups, the inpatient cost of nursing in the uterine artery embolization group was the lowest. The total inpatient cost of uterine artery embolization ($1007.44 ± $60.65 [Canadian dollars]) was significantly lower than the cost of total abdominal hysterectomy ($1933.37 ± $47.68 [Canadian dollars]), abdominal myomectomy ($1781.73 ± $47.16 [Canadian dollars]), and vaginal hysterectomy ($1515.39 ± $66.72 [Canadian dollars]; P <.001). Sixteen of the 85 patients (18.8%) were hospitalized after uterine artery embolization, mainly for abdominal pain. Conclusion: Compared with abdominal myomectomy, abdominal hysterectomy, and vaginal hysterectomy, uterine artery embolization is associated with a lower hospital cost and a shorter hospital stay. Hospitalization after uterine artery embolization is mainly for abdominal pain after the procedure. A better method of pain control to reduce the rate of hospitalization and its cost is needed. (Am J Obstet Gynecol 2002;187:1401-4)

Histerectomia Laparoscópica em um Hospital Geral Comunitário Experiência Inicial e Comparação de Custos Hospitalares

Objetivo: comparar os custos hospitalares entre a histerectomia vaginal assistida por laparoscopia (HVAL) e a histerectomia total abdominal (HTA), relatando a experiência inicial com a nova abordagem em um hospital geral comunitário. Pacientes e Métodos: foram comparados 11 casos de HVAL e 23 de HTA, realizados de setembro de 1998 a julho de 1999. Prontuários e demonstrativos das despesas hospitalares de cada paciente foram revistos para coletar as variáveis analisadas. Resultados: não houve diferença estatística entre os grupos quanto à idade, paridade e cirurgia abdominal prévia. A principal indicação cirúrgica para ambos os grupos foi leiomiomatose uterina. O grupo das HVAL apresentou tempo de internação menor, com mediana de 1 dia e o das HTA, de 2 dias (p<0,01). As HVAL mostraram-se 40,2% mais caras que as HTA (p<0,01). Os gastos de centro cirúrgico contribuíram com a maior parte dos custos hospitalares para ambos os grupos, correspondendo a 79,8 e 57,9% do total para as HVAL e HTA, respectivamente. Os gastos de enfermaria para as HVAL foram menores que para as HTA, com diferença estatisticamente significativa (p = 0,002). Conclusão: com menor tempo de internação e com custos de enfermaria menores demonstramos que a HVAL propicia melhores condições de pós-operatório e recuperação mais rápida que a HTA. A HVAL, quando executada em um hospital geral comunitário, apesar de mais cara que a HTA, é uma ótima opção para a remoção uterina, e deve fazer parte do arsenal terapêutico dos cirurgiões ginecológicos.

Laparoscopic-Assisted Vaginal Hysterectomy for Endometrial Cancer: Clinical Outcomes and Hospital Charges

Objective.Our objective was to compare the clinical outcomes and associated hospital charges between two methods of hysterectomy for patients with early-stage endometrial cancer.Methods.Retrospective chart review of 320 patients with early-stage endometrial cancer treated by laparoscopic-assisted vaginal hysterectomy (LAVH) or total abdominal hysterectomy (TAH) was performed for the period of July 1, 1991, to September 30, 1996, at Memorial Sloan-Kettering Cancer Center.Results.Sixty-nine patients (22%) were treated by LAVH, and 251 (78%) were treated by TAH. The majority of the patients (80%) had Stage I disease. The mean age was similar for both groups: 60 years for the LAVH vs 61 years for TAH. The mean weight was significantly lower for the LAVH group, 71 kg (range 43–117 kg), than for the TAH group, 82 kg (range 38–200 kg), (P< 0.05). Overall complication rates were lower among patients treated by LAVH. Operating room time was longer for the LAVH group (214 min) than for the TAH group (144 min) (P< 0.05). The median length of stay was significantly shorter for patients treated by LAVH (2.0 days) compared to TAH (6.0 days) (P< 0.05). Room charges were significantly higher for the TAH patients ($6960) compared to the LAVH patients ($3130) (P< 0.05). Overall mean total charges were significantly less for the LAVH group ($11,826) than for the TAH group ($15,189) (P< 0.05). With a median follow-up of 30 months for the TAH group and 18 months for the LAVH group, there was no significant difference in disease recurrence (P= 0.91).Conclusion.Patients treated by LAVH for early-stage endometrial cancer had significantly shorter hospitalization and fewer complications, resulting in less overall hospital charges when compared to patients treated by TAH. Long-term outcome was similar. Laparoscopic-assisted vaginal hysterectomy is an attractive alternative for selected patients with early-stage endometrial cancer.

Postoperative Immosuppression in Patients Undergoing Laparoscopic Assisted Vaginal Hysterectomy versus Total Abdominal Hysterectomy: Preliminary Results

Postoperative immunosuppression has been documented in healthy individuals following elective surgery, trauma, and bums. Both cellular immunity and humoral immunity are depressed transiently, the severity of which is correlated with the length of hospital stay, infectious morbidity, and mortality. The present study was designed to compare the degree of immunosuppression in patients undergoing laparoscopic assisted vaginal hysterectomy (LAVH) versus total abdominal hysterectomy (TAH). Total T cell count, B cell count, and delayed hypersensitivity response to intradermal injection of PPD antigen were documented preoperatively and on postoperative days 3 and 7. There was a significant fall in T cell count on day 3, which tended to normalize by day 7 in the TAH group, but no change was seen in the postoperative T cell count in the LAVH group. No significant change was observed in the B cell count in either group. In the TAH group, two of three patients who showed positive skin response to PPD preoperatively had a negative response after surgery, while in the LAVH group, the patients who had a positive response before continued to do so after surgery. These preliminary results suggest that there is a lesser degree of derangement of the immune system in patients undergoing LAVH than in those undergoing open hysterectomy, which may be a significant factor contributing to a shorter convalescence after laparoscopic surgery. This trend, however, needs further confirmation in a larger patient population. (J GYNECOL SURG 15:67, 1999)

Laparoscopic and abdominal hysterectomy: a cost comparison

To compare the cost of laparoscopically assisted vaginal hysterectomy (LAVH) with that of total abdominal hysterectomy (TAH) under casemix. Retrospective comparison of the costs, operating time and length of hospital stay. The 16 women undergoing consecutive LAVH and 16 age-matched women undergoing TAH between 1 February 1994 and 31 July 1995; all women were public patients undergoing hysterectomy for benign disease. Monash Medical Centre, a large tertiary teaching hospital in Melbourne, Australia, where casemix is used to determine funding and budget allocation. The difference between the costs of the two procedures was not statistically significant (P = 0.5), despite the cost of laparoscopic hysterectomy including that of disposables. The mean operating time for TAH was 86 minutes (95% CI, 65.5-106.5), compared with 120 minutes (95% CI, 100.8-140.5) for LAVH (P < 0.01). The mean length of stay in the TAH group was 5.75 days, compared with 3.25 days in the LAVH group (P < 0.001). In hysterectomy for benign gynaecological disease, the laparoscopic procedure costs the same as the total abdominal procedure. Audit such as this is important in patient management and in guiding hospitals in funding and bed allocation.

Vaginal hysterectomy by uterine morcellation: An efficient, non-morbid procedure

To evaluate the relationship between uterine size and a possible increase in operative morbidity and procedure failure rates in women undergoing total vaginal hysterectomy. A retrospective chart analysis of all hysterectomies performed for histologically confirmed leiomyomata was completed. A total of 128 cases qualified. Patients were stratified into three groups: group I, patients undergoing vaginal hysterectomy with a uterine weight of 300 g or greater but less than 1000 g; group II, patients undergoing vaginal hysterectomy with a uterine weight of 100-299 g; and group III, patients undergoing abdominal hysterectomy with a uterine weight of 100-1000 g. The variables evaluated included the following: length of hospital stay, operative time, estimated blood loss, and operative complications. Data regarding failed vaginal hysterectomy requiring an abdominal approach were also obtained. Both vaginal hysterectomy groups had a significantly reduced length of stay compared with the total abdominal hysterectomy group. There was no significant difference in mean estimated blood loss between groups I and III. Similarly, there were no significant differences in complication rates among the three groups. Group I had an 84% (31 of 37) success rate versus 95% (40 of 42) for group II (not statistically significant). There were no significant differences in the mean uterine weight, estimated blood loss, and complication rate in unsuccessful versus successful vaginal hysterectomies. The estimated blood loss was significantly higher for unsuccessful vaginal hysterectomy. Uterine size alone is not an absolute contra-indication to vaginal hysterectomy. Large uterine size (greater than 300 g) was not related to a significant increase in failed vaginal hysterectomy. Conversely, failed vaginal hysterectomy was not size-dependent. Furthermore, there is no additional operative morbidity when vaginal hysterectomy is converted to a total abdominal hysterectomy because of a technical inability to complete the surgery vaginally.

Laparoscopic-assisted vaginal hysterectomy: A case control comparative study with abdominal hysterectomy

A case control study of the operative time, blood loss, time for return to work, pain levels, and medications was conducted comparing laparoscopic-assisted vaginal hysterectomies (LAVH) with total abdominal hysterectomy (TAH). The average operating time for LAVH was 151 minutes whereas for TAH it was 99 minutes (P<.01). The average length of stay for the LAVH was 2.5 days and for the abdominal hysterectomy it was 3.5 days (P<.01). During hospitalization the LAVH group required an average of 180 mg of meperidine while the TAH group required 414 mg of meperidine (P<.01). Patients undergoing LAVH reported activity levels of 9.2 on a scale of 1 to 10, with 10 being unlimited activity, by day 14. Abdominal hysterectomy patients' activity was reported as only 6.4 on the same scale (P<.005). The LAVH group, although requiring more operating time, made a more rapid recovery, and less pain medication, and required shorter hospitalization than the TAH group.

Clinical and financial analyses of laparoscopically assisted vaginal hysterectomy versus abdominal hysterectomy

Study Objective. To perform clinical and financial analyses of laparoscopically assisted vaginal hysterectomy (LAVH) and total abdominal hysterectomy (TAH). Design. During the 16 months between August 1991 and December 1992, 34 women who underwent LAVH were compared with 60 women having a TAH during 1990. Indications, surgical outcomes, complications, time to return to work, and hospital charges for each group were analyzed. Setting. A multispecialty group practice. Patients. The LAVH group included the first 34 cases by the senior author and were the only such procedures at this hospital. The TAH group included all patients having this procedure for benign conditions from the same group practice for 1990. Interventions. Either LAVH or TAH. Measurements and Main Results. The most common primary indication in both groups was fibroids. Only one LAVH failed and was converted to a TAH. Postoperative complications were significantly greater for TAH than for LAVH (45% vs 9%). The length of stay and time to return to work were significantly less after LAVH. Total hospital charges increased for LAVH over TAH ($7623 vs $4550) despite a significantly shorter length of stay after LAVH. Conclusions. Although LAVH has a significantly lower complication rate than TAH, it is more costly to perform. This higher cost, despite a shorter hospital stay, is attributed to high operating room charges. Employers and patients benefit from early return to work with LAVH.

A Comparison of Laparoscopically Assisted Vaginal Hysterectomy and Abdominal Hysterectomy

The goal of this study was to compare laparoscopically assisted vaginal hysterectomy (LAVH) with total abdominal hysterectomy (TAH). We performed a prospective comparison of the hospital courses of 30 women, 15 undergoing LAVH and 15 undergoing TAH, in a teaching hospital setting. Analysis of variance (ANOVA) was used, with statistical evaluation of differences by Student's t-test for normally distributed data and Kruskal-Wallis for data with dissimilar variances. Fourteen of fifteen patients scheduled for LAVH had their surgery completed without need of a laparotomy. In the LAVH group, (1) mean surgical time was 50 minutes longer, (2) blood loss, complications, and hospital costs were not statistically different, (3) hospital days averaged 1 1/2 less, and (4) postoperative pain ratings and medication requirements were significantly decreased, compared with the TAH group. In many cases, LAVH may be reasonably performed instead of an indicated TAH.