The comparison of laparoscopic assisted vaginal hysterectomy, total vaginal hysterectomy and total abdominal hysterectomy

Min, Byoung Kang; Park, Joon Suk; Ryu, Ji Hoon; Kim, Eok Bae; Shim, Sam Young; Song, Young Rae; Kim, Ki Hwan; Kang, Kyung Hwa; Lee, Byung Kwan; Rho, Jeong Hoon; Oh, Kwan Young; Yang, Yoon Seok; Hwang, In Taek

Abstract

OBJECTIVE
To compare the clinical results for women undergoing total abdominal hysterectomy (TAH), laparoscopic assisted vaginal hysterectomy (LAVH) and total vaginal hysterectomy (TVH).
METHODS
We reviewed the medical records of patients who underwent TAH (n=97), LAVH (n=112) and TVH (n=95) from June 2002 to June 2005. We compared and evaluated patient's characteristics, previous abdominal operation histories, indication of hysterectomy, uterine weight, operative time, perioperative hemoglobin and hematocrit change, the degree of postoperative pain, hospital stay and complications.
RESULTS
The patient's characteristic (age, weight, height, parity, perioperative hemoglobin and hematocrit change, complication rate) had no statistical difference in all three groups. In the TVH group, the rate of previous abdominal operations (25%) was significantly lower than TAH (56%), and LAVH (40%) (p=0.023). The mean uterine weight was the heaviest in TAH group (443.6+/-407.3 g), compared to LAVH group (301.9+/-133.9 g) and TVH group (225.3+/-91.8 g) (p<0.001). Operative time was the longest for LAVH group (p=0.001), and there was no significant difference between TAH group and TVH group (p=0.087). The TAH group had the highest postoperative pain scale and the length of hospital stay. The LAVH group and TVH group had almost the same postoperative pain scale and the length of hospital stay.
CONCLUSION
Both LAVH and TVH had the following advantages compared with total abdominal hysterectomy: less pain, shorter hospital stay, cosmetic advantages. But limited operation field in TVH and expensive operative cost in LAVH were disadvantages. Specific guidelines for determining the route of hysterectomy result in decreased morbidity and lower costs, and thus the gynecologist can ensure that the patient receives the best possible surgical care.