Laparoscopically Assisted Vaginal Hysterectomy: A Review of 43 Cases

Kang, Y P; Lee, S N; Kang, C G; Lee, J Y; Kim, D J; Kee, K S; Im, H J

Abstract

Hysterectomy is the most common gynecologic operation. Traditionally, hysterectomy was performed either through an abdominal approach or through a vaginal approach. The merits, indications, and contraindications for each approach have been debate for many years. Complication rate of vaginal hysterectomy is lower than abdomnal hysterectomy but, only 30% of hysterectomy was performed through a vaginal approach. With the addition of laparoscope in hysterectomy, it offers a technique to convert some abdominal hysterectomies into vaginal hysterectomies. This clinical study is a retrospective review of 43 cases of laparoscopically assisted vaginal hysterectomy (LAVH) between May 1997 and Feb 1998. We used simple electrosurgical technique and avoid the use of disposable staples and other instruments. The surgical indications of hysterectomy were myoma uteri (51.2%), dysmenorrhea and pelvic pain (20.9%), dysfunctional uterine bleeding (18.6%), cervical intraepithelial neoplasia (7.0%), and others (2.3%). Average operative time was 123.14+/-37.99 minutes. The mean uterine weight was 276.40+/-119.83 gram. The mean blood loss was 304.07+/-212.41 ml. The most common associated procedure with LAVH was unilateral salpingoophorectomy, which comprise 11.6%, posterior colporrhaphy (9.3%), adhesiolysis (7.0%), bilateral salpingoophorectomy (2.3%), salpingectomy (2.3%) were also carried out concomitantly. The comlication rate was 11.6% and the most common one is blood transfusion (6.9%). But, compared with other route of hysterectomy, overall complication rate was markedly decreased. This report suggest that LAVH can decrease the number of patients requiring a laparotomy for hysterectomy. It appears useful when adnexal indication for surgery or adhesion is exists. And it provides a shorter hospital stay, quicker recovery, fewer complications than those undergoing the same procedeure abdominally. But, operative time and blood loss were increased than abdominal hysterectomy.