Clinical Analysis of Laparoscopic assisted Vaginal Hysterectomy

Kang, Byung Hee; Seo, Jung Ho; Park, Hyoung Moo; Hur, Min

Abstract

Laparoscopy is a procedure that uses a narrow telescope to view the interior of abdominal cavity. Medical endoscopy was introduced a long time ago, but rapid progress and technological advances in laparoscopy have been witnessed during past two decades. Operative laparoscopy was developed during the 1970s, and laparoscopy was first used during the early 1980s. And now, hynecologic surgery may be performed laparoscopically in 30% to 80% of patients currently undergoing laparotomy. More recently, with an improvement in our ability to maintain intraabdominal hemostasis, complex surgical precedures are able to be performed laparoscopically. We used laparoscopic hysterectomy from 1991. At that time, we experienced many complications byt now performed successful laparoscopic hysterectomy due to sdillful surgical technique and improvement in surgical devices. So, we report surgical experiences from April 1991 to October 1996 and divided the patients into 3 groups. The 1st, 2nd and 3rd group underwent laparoscopic hysterectomy were 1991-1992, 1993-1994, 1995-1996, respectively. The number of patient underwent laparoscopic hysterectomy was 300,300,300, respectively. The results were as follows.1) The mean age of each group patient was 41.4 +/- 7.3, 43.6 +/- 6.9, 44.4 +/- 7.1, respectively. 2) The mean parity of all group was 2.2 +/- 1.3, 2.5 +/- 1.2, 2.3 +/- 1.1, respectively. 3) The most common operative indication was myoma uteri in all group. The 2nd most common indication was chronic pelvic pain in 1st, 2nd group and intractable menorrhagia in 3rd group. Other indications were carcinoma in situ, uterine prolapse, adenomyosis, endometriosis, chronic or severe infection, adnexal mass,. etc. 4) The mean hemoglobin change of all group from preoperative day to postoperative 1 day was 2.1 +/- 1.5 g/dl, 1.9 +/-1.2 g/dl, 1.5 +- 1.1 g/dl, respectively. %5) The mean operative time of all group was 158.4 +/- 43.2 minutes, 116.9 +/- 36.5 minutes, 69.8 +/- 23.2 minutes, respectively. 6) The mean uterine weight of all group was 178.3 +/- 79 gm, 186.2 +/- 89 gm, 188.5 +/- 92.5 gm, respectively. 7) The most common complication was subcutaneous emphysema in all group. Other complications were ureteral injury, vesico-/uretero-vaginal fistula, intestinal injury, bladder dysfunction and injury, hemorrhage due to vessel injury, incisional hernia, peroneal nerve palsy. etc.