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.     

A prospective randomized comparison of vaginal hysterectomy,laparoscopically assisted vaginal hysterectomy,and total laparoscopic hysterectomy in women with benign uterine disease

Objectives

To compare the clinical results of three minimally invasive hysterectomy techniques: vaginal hysterectomy (VH), laparoscopically assisted vaginal hysterectomy (LAVH), and total laparoscopic hysterectomy (TLH).

Study design

A prospective, randomized study was performed at a tertiary care center between March 2004 and October 2005. A total of 125 women indicated to undergo hysterectomy for benign uterine disease were randomly assigned to three different groups (40 VH, 44 LAVH, and 41 TLH). Outcome measures, including operating time, blood loss, rate of complications, inflammatory response, febrile morbidity, consumption of analgesics, and length of hospital stay, were assessed and compared between groups.

Results

Vaginal hysterectomy had the shortest operating time (66 min) and smallest drop in hemoglobin. However, there were technical problems with salpingo-oophorectomy from the vaginal approach (3/20 cases) and this group had a significantly higher rate of febrile complications (20%) compared to LAVH (2.3%) and TLH (7.3%). The increase in inflammatory markers was higher in vaginal hysterectomy patients. Laparoscopically assisted vaginal hysterectomy had an acceptable operating time (85 min), a low complication rate, lack of severe post-operative complications, and the lowest consumption of analgesics. However, it had the highest blood loss. Total laparoscopic hysterectomy had the longest operating time (111 min) and severe complications occurred only in this group. Conversions to another hysterectomy method occurred in all three groups, most of these conversions were to LAVH.

Conclusions

Based on our results, in women with non-malignant disease of the uterus, LAVH and VH seem to be the preferred hysterectomy techniques for general gynecological surgeons. Vaginal hysterectomy had the shortest operating time and least drop in hemoglobin, making it a suitable method for women for whom the shortest duration of surgery and anesthesia is optimal. LAVH is a versatile procedure, combining the advantages of both the vaginal and laparoscopic approach, and is preferable in cases when oophorectomy is required. Total laparoscopic hysterectomy did not appear to offer any significant benefits over the other two methods and should be strictly indicated in women where neither VH nor LAVH are feasible and should only be performed by very experienced laparoscopists.     

A prospective comparison of single-port laparoscopically assisted vaginal hysterectomy using transumbilical GelPort access and multiport laparoscopically assisted vaginal hysterectomy

Objective

To evaluate the feasibility and safety of single-port laparoscopically assisted vaginal hysterectomy (SP-LAVH) using transumbilical GelPort access.

Study design

A prospective case–control study was performed at a University teaching hospital between January 2009 and March 2010, a total of 242 women with a uterus ≤16 weeks gestational size were enrolled in the study. Eighty women underwent SP-LAVH using transumbilical GelPort access (SP-LAVH group), and 162 women underwent conventional multiport LAVH (conventional LAVH group).

Results

There were no statistical differences between groups in the patients’ demographic characteristics, median operating time (92.5 vs. 90 min; P = 0.479), postoperative changes in hemoglobin concentration (1.4 vs. 1.4 g/dL; P = 0.290), weight of the resected uterus (246 vs. 256 g; P = 0.098), return of bowel activity (37.1 vs. 39.8 h; P = 0.103), hospital stay (3 vs. 3 days; P = 0.554), complication rate (3.8 vs. 4.3%; P = 1.000), and the rate of using an additional trocar or conversion to laparotomy (1.3 vs. 0.6%; P = 0.553).

Conclusions

SP-LAVH using transumbilical GelPort access is feasible and safe in women with a uterus ≤16 weeks gestational size. However, a large prospective randomized study is needed to confirm this conclusion and to establish guidelines for the use of SP-LAVH.     

腹腔镜辅助阴式子宫切除术与阴式子宫切除术适应证的探讨

目的通过比较腹腔镜辅助阴式子宫切除术(LAVH)与阴式子宫切除术(VH)的不同手术适应证及效果,探讨LAVH与VH手术病人的最佳选择。方法回顾性分析上海瑞金医院1999年6月至2002年12月间LAVH与VH手术病例381例,比较两种手术在手术时间、出血量、术后住院日、术中术后并发症及两者的手术适应证,尤其是子宫大小、盆腔粘连等的不同。结果两组手术在术中出血、手术并发症等方面差异无显著性意义,LAVH手术时间较长与患者子宫大、盆腔粘连者多、手术难度大有关。VH组患者均为正常或小于正常大小的子宫、无盆腔粘连、不伴有附件疾病者,手术适应证明显受限制。结论VH与LAVH均为创伤小、恢复快的微创手术,但VH适合于子宫小、无粘连并伴下垂者,而LAVH扩大了VH的适应证,是值得推广的手术。     

Laparoscopically assisted vaginal hysterectomy as an alternative to abdominal hysterectomy in patients with fibroids

Objective: Introduction of laparoscopically assisted vaginal hysterectomy (LAVH) was evaluated for its usefulness to replace abdominal hysterectomy in fibroids. Study design: A total of 240 women with a mean age of 46.7 years underwent hysterectomy over a period of one year. The technique of LAVH was introduced starting in the second quarter of the study period. Clinical data of 60 patients undergoing either LAVH or abdominal hysterectomy for fibroids were compared in a cross-sectional study by χ ²- and t-test. Results: A comparison between the first and the last quarter of the study period showed that the rate of abdominal hysterectomies decreased from 66% to 12%, whereas LAVH increased from 0 to 40% (p < 0.05). The rate of vaginal hysterectomies remained between 34% and 48%. Compared to abdominal hysterectomy, LAVH operating time was about 1/3 longer, hospital stay was shorter (3 days), and LAVH proved more cost-effective than abdominal hysterectomy (significance of all differences: p < 0.05). Conclusions: LAVH is a valid alternative to abdominal hysterectomy in fibroids. Received: 10 April 1996 / Accepted: 15 August 1996     

A comparison of laparoscopically assisted vaginal hysterectomy vs traditional total abdominal and vaginal hysterectomies

The objective of this work was to compare laparoscopically assisted vaginal hysterectomy to traditional total abdominal and vaginal hysterectomies in seven critical areas: anesthesia time, surgery time, hospital stay, operative blood loss, total analgesic use, time required to return to work, and total cost of each of these procedures. The first 25 unscreened, consecutive laparoscopically assisted vaginal hysterectomies performed by the senior author were compared with 25 randomly selected traditional total abdominal and 25 randomly selected vaginal hysterectomies performed by the senior author's professional corporation. Laparoscopically assisted vaginal hysterectomy compared favorably to abdominal and vaginal hysterectomy in three areas and was superior to both total abdominal hysterectomy and vaginal hysterectomy in the remaining four areas. Although the use of the endoscopic stapling device and laser made the laparoscopically assisted vaginal hysterectomy a more expensive procedure than traditional vaginal hysterectomy, the expense was not significant and was justified by the decreased surgery time. The results of this comparative study suggest that laparoscopically assisted vaginal hysterectomy is superior or comparable to total abdominal hysterectomy and vaginal hysterectomy, especially for patients who may not have been candidates for vaginal hysterectomy. This procedure has allowed the gynecologic endoscopic surgeon to convert abdominal to vaginal procedures. Laparoscopically assisted vaginal hysterectomy provides an overall cost savings to the patient, has a low complication rate, adapts well to the outpatient setting, causes less patient discomfort, and allows the patient to return rapidly to home and workplace.     

Comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy: a randomized controlled trial

ObjectiveTo compare intraoperative hemorrhage and other operative parameters after laparoscopically assisted vaginal hysterectomy (LAVH) versus total abdominal hysterectomy (TAH) for benign gynecologic conditions.DesignA prospective, randomized, controlled trial.Materials and MethodsBetween 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 MeasuresIntraoperative blood loss, operating time, postoperative analgesic requirements, perioperative complications, and duration of hospitalization.ResultsIntraoperative 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.ConclusionsThe 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.     

A prospective randomised study of total laparoscopic hysterectomy,laparoscopically assisted vaginal hysterectomy and non-descent vaginal hysterectomy for the treatment of benign diseases of the uterus

Aims and objectives  

To compare the three techniques of hysterectomy—total laparoscopic hysterectomy (TLH), laparoscopic assisted vaginal hysterectomy (LAVH) and non-descent vaginal hysterectomy (NDVH).     

Two-port method for laparoscopically assisted vaginal hysterectomy: approach and outcomes

The aim of our study was to assess the feasibility and efficacy of laparoscopically assisted vaginal hysterectomy (LAVH) with the two-port method. One hundred seventy-six women with uterine diseases underwent LAVH using the two-port method. We reviewed the medical records of the patients’ age, parity, body mass index, history of previous abdominal surgery, operative indications, histopathological diagnosis, operating time, weight of the removed uterus, change in the hemoglobin levels, hospital stay, and occurrence of any complications. The median age of the patients was 46 years (range, 33–60 years), the median parity was 2 (range, 0–5), and the median body mass index was 23.4 kg/m² (range, 17.6–29.6 kg/m²). Forty-two patients (23.9%) had previous abdominal operative history. The most common operative indication was menorrhagia, and the most common histopathological diagnosis was leiomyoma. The median operating time was 58 min (range, 30–150 min), and the median weight of the removed uterus was 230 g (range, 60–660 g). The median change in the hemoglobin level was 1.7 g/dL (range, 0.1–3.8 g/dL). The median hospital stay was 3 days (range, 2–7 days). An ileus occurred postoperatively in one patient, which was managed conservatively. No additional port was required in any of the cases. No operation was converted to an abdominal hysterectomy. LAVH using the two-port technique with the aid of a 5-mm telescope and an endoscopic stapler is both feasible and efficient.     

Comparison between bisection/morcellation and myometrial coring for reducing large uteri during vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy: results of a randomized prospective study

BACKGROUND: Vaginal hysterectomy (VH) is being performed increasingly by gynecologic surgeons. Thus, enlarged uteri are more frequently removed vaginally, requiring reducing techniques to allow vaginal extraction. MATERIAL AND METHODS: We designed a randomized prospective study to compare bisection-morcellation and myometrial coring. Patients scheduled for VH or laparoscopically assisted vaginal hysterectomy (LAVH) were offered entry into the study. Endometrial cancer was an exclusion criterion. Uterine size was not a contraindication for vaginal surgery. We compared data from preoperative workup as well as from the operative and the postoperative course. Data were recorded prospectively. Results were analyzed with nonparametric tests and logistic regression models. RESULTS: Thirty patients were included in the study. Patients were similar in both groups. No severe peroperative complication occurred in this series. Operating time was comparable in both groups. Uteri weighed more than 280 g in more than 70% of patients in both groups. Myometrial coring failed more often than bisection-morcellation (25% vs. 0%, p = 0.06). Patients and uteri characteristics had no influence on the risk of failure, except for narrow uteri, which were associated with an increased risk of failure in the myometrial coring group only (68.3 vs. 83.9 mm, p = 0.01). Postoperative courses were similar for the two techniques, except for an increased rate of fever in the myometrial coring group (28%, p = 0.03). CONCLUSION: Both techniques appeared safe in this trial. Myometrial coring failed more frequently than bisection-morcellation, especially in the case of a narrow uterus. Postoperative fever was significantly more common after myometrial coring. Both techniques should be taught to resident surgeons.     

Early experience of laparoscopically assisted radical vaginal hysterectomy (Coelio-Schauta) versus abdominal radical hysterectomy for early stage cervical cancer

The objective of this study was to compare outcomes of laparoscopically assisted radical vaginal hysterectomy (LARVH) vs. abdominal radical hysterectomy (RH) for early-stage cervical cancer. This is a retrospective study of all LARVH and RH procedures between January 2003 and June 2006 in our tertiary referral centre. Demographic, intraoperative and postoperative parameters in both groups were compared. Fourteen women (stage IA2–IB) underwent LARVH, and 12 women (stage IA2 to IB) had RH. All had clear excision margins. None of the laparoscopic procedures were converted into laparotomy. There have not been any recurrences in either group during the follow-up period. We conclude that LARVH and RH are equally efficacious surgical methods. The LARVH group had shorter hospital stay, reduced blood loss, shorter bladder recovery time, less postoperative complications but higher intraoperative injury rate in comparison to RH. This may reflect the learning curve of this new procedure.     

Comparative study of vaginal,laparoscopically assisted vaginal and abdominal hysterectomies for uterine myoma larger than 6 cm in diameter or uterus weighing at least 450 g: a prospective randomized study

BACKGROUND: The purpose of this study was to compare peri-operative morbidity, preoperative sonographic estimation of uterine weight and postoperative outcomes of women with uterine fibroids larger than 6 cm in diameter or uteri estimated to weigh at least 450 g, undergoing either vaginal, laparoscopically assisted vaginal or abdominal hysterectomies. METHOD: Ninety patients who met the criteria of uterine fibroids larger than 6 cm by ultrasonographic examination were included in our prospective study. Patients were randomized into laparoscopic-assisted vaginal hysterectomy (30 patients), vaginal hysterectomy (30 patients) and abdominal hysterectomy (30 patients) groups. RESULTS: The laparoscopically assisted vaginal hysterectomy group had significantly longer operative times than the abdominal and vaginal hysterectomy groups (109 +/- 22 min, 98 +/- 16 min, and 74 +/- 22 min, respectively, p < 0.001). Blood loss for vaginal hysterectomy was significantly lower than for either abdominal or laparoscopically assisted vaginal hysterectomies (215 +/- 134 ml, 293 +/- 182 ml, and 343 +/- 218 ml, respectively, p = 0.04). Vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy groups had shorter hospital stays, lower postoperative pain scores, more rapid bowel recovery and lower postoperative antibiotic use than the abdominal hysterectomy group. Uterine weight in the abdominal hysterectomy group was significantly heavier than in the vaginal and laparoscopically assisted vaginal hysterectomy groups (1020 +/- 383 g, 835 +/- 330 g, and 748 +/- 255 g, respectively, p = 0.02). We estimated that when a myoma measured between 8 and 10 cm, the uterus weighed approximately 450 g, and the sensitivity of this prediction was 57.5%. For a myoma larger than 13 cm, the estimated uterine weight was more than 900 g and the sensitivity of this prediction was 71%. CONCLUSION: The study shows vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy can be performed in women with uterine weight of at least 450 g. Preoperative ultrasonographic examination can provide the surgeon with valuable information on the size of the fibroid and the estimated weight of the enlarged uterus before implementing a suitable surgical method.     

Assessing the impact of introducing laparoscopically assisted vaginal hysterectomy into a community-based gynecology practice

This study was undertaken to determine the effects of introducing laparoscopically assisted vaginal hysterectomy (LAVH) into a community-based gynecology practice on the route of hysterectomy, operating time, patient costs, length of hospitalization, and morbidity, including complications and blood loss. All patients in the author's practice who had hysterectomies during the 10 months before completion of an advanced operative laparoscopy course were compared with the patients having a hysterectomy in the 10 months after the course. The route of hysterectomy, surgery time, length of hospital stay, preoperative and postoperative hemoglobin, uterine weight, diagnoses, and historical clinical data were compared between the two groups using a level of significance (alpha = 0.01) to assess statistical relevance. The rate of vaginal hysterectomy was remarkably higher in the AFTER group (53.2%, n = 62) vs the BEFORE group (27.7%, n = 65). The AFTER group had a significantly shorter hospital stay (3.4 days +/- 1.22 vs 4 days +/- 1.26, p < or = 0.01) but a much longer surgery time (115.9 min +/- 38.98 vs 80.1 min +/- 27.95, p < or = 0.01). There was no real difference in complication rates or fall in hemoglobin between the two groups. When LAVH was compared with TAH, the LAVH patients tended to be younger (37.4 +/- 8.66 vs 46.2 +/- 16.5 years) and to have a shorter hospital stay (3.1 +/- 0.99 vs 4.1 +/- 1.27 days), a longer surgery time (114.9 +/- 37.45 vs 85.3 +/- 33.74 min), and a bigger hospital bill ($6245 +/- 380 vs $5140 +/- 410) than patients with TAH.(ABSTRACT TRUNCATED AT 250 WORDS)