Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: A prospective, randomized, multicenter study (original) (raw)
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European Journal of Obstetrics & Gynecology and Reproductive Biology, 2015
Objective: To evaluate surgery-related outcomes of laparoscopic (LH) and vaginal hysterectomy (VH) in patients with a history of previous cesarean section (CS). Study design: Data on 289 consecutive patients with a history of CS undergoing VH (n = 49, 17%) and LH (n = 219, 76%) were collected. Basic descriptive statistics, univariate and multivariate analyses were performed to evaluate surgery-related outcomes. A propensity-matched algorithm was applied in order to reduce allocation biases between groups. Results: Patients undergoing LH were more likely to have a history of multiple cesarean sections (44% vs. 18%; p = 0.001). Additionally, uterine weight was greater among patients undergoing LH than VH (median weight: 235 (range, 45-2830) vs. 150 (range, 40-710) g; p < 0.001). Three patients in each group experienced procedural bladder injuries (3/219 (1%) vs. 3/49 (6%); p = 0.07; RR: 1.65; 95%CI: 0.74, 3.68). The rate of grade 3 or worse postoperative complications was balanced between LH and VH (1% vs. 0%; p = 1.00). Patients undergoing LH experienced a shorter length of hospital stay in comparison to patients undergoing VH (1 vs. 2 days; p = 0.02). Considering the overall population, we observed via multivariate analysis that age (OR: 1.003 (95%CI: 1.001, 1.004) per 10-year increase in age; p = 0.002), VH (OR: 17.80 (95%CI: 1.762, 180,378); p = 0.01) and number of cesarean sections ! 2 (OR: 27.70 (95%CI: 1.976, 388,285); p = 0.01) increased the risk of developing bladder injuries during hysterectomy. Conclusions: LH is a safe and feasible procedure in patients with previous CS, and it is associated with a low bladder injury rate.
Laparoscopically assisted vaginal hysterectomy compared with total abdominal hysterectomy
American Journal of Obstetrics and Gynecology, 1999
We report 190 cases where laparoscopy assisted vaginal hysterectomy (LAVH) was used as a primary procedure when the patients were not suitable candidates for a vaginal hysterectomy (VH) either because of lack of prolapse or multiple abdominal surgeries. All the surgeries were done by the same gynecologist. A total of 209 cases were performed, but 8 cases (3.8%) have been converted to TAH because of intraoperative bleeding or severe adhesions. The remaining 201 (96.2%) cases have been completed as LAVH. In this study we have evaluated only 190 cases as 19 cases had additional associated surgeries or incomplete records. The average operating time was 117 ± 25.9 min, the intraoperative blood loss was 242.3 ± 213.3 mL, and the average hospitalization was 0.7 ± 0.7 days. Although the operating time and intraoperative blood loss over a span of time showed significant reduction, the hospitalization did not show any significant change. The complication rate was 6.6%. The average hospitalization cost excluding the surgeons and anesthesiologist charges was $3936.00. With these findings we have concluded that regardless of preoperative diagnosis and findings when vaginal hysterectomy is not suitable, LAVH is a viable alternative to TAH. To the best of our knowledge this is the first article discussing this particular approach.
Comparison of Laparoscopically Assisted Vaginal Hysterectomy and Total Abdominal Hysterectomy
2008
Background: Hysterectomy is the second most common major surgery procedure done after cesarean section by gynecologists in many countries and the most common procedure is total abdominal hysterectomy (TAH). The incidence of laparoscopically assisted vaginal hysterectomy (LAVH) performed for benign lesions has progressively increased in recent years. Our objective was to compare the relative advantages and disadvantages of LAVH and TAH procedures. Methods: A clinical trial was performed on patients who were candidates for hysterectomy with benign reasons in Arash hospital from March 2006 to April 2007. By simple randomization, 90 patients (30 for LAVH and 60 for TAH) were selected. Demographic details and intra-operative and post-operative complications were recorded by the staff and were compared between the two groups. Results: On average, LAVH operations took significantly longer than TAH operations (100.17 ± 39.35 minutes; 145.83 ± 41.55 minutes; P< 0.0001). The total length o...
The Journal of the American Association of Gynecologic Laparoscopists, 2003
The American Association of Gynecologic Laparoscopists (AAGL) has been conducting membership surveys since 1976. Originally, surveys were designed to evaluate only sterilization techniques. As increasingly complicated operative laparoscopic operations became more widely accepted, it was apparent that laparoscopic-assisted vaginal hysterectomy (LAVH) was the most significant surgical procedure performed by most of the membership. Since 1989 the AAGL has actively attempted to document various aspects of LAVH through surveys of its members. The first survey in 1995 attempted to gain information as to current performance of the procedure and to assess relative frequencies and complications. Dr. Barbara S. Levy, who designed the 1995 survey with Drs. Jaroslav F. Hulka and William H. Parker, wrote this instrument, which was developed with few modifications from the earlier one to allow comparisons to be made between time periods. A total of 4437 surveys were mailed to AAGL members and contained 50 questions on laparoscopy, particularly LAVH, performed from January 1, 2000, to December 31, 2000. As in all AAGL surveys, the replies were strictly anonymous and confidential so that reporting of complications might be as frank as possible.
Vaginal hysterectomy following previous cesarean section
International Journal of Gynecology & Obstetrics, 1995
Objective: To determine whether hysterectomy by the vaginal route is safe and feasible in patients with previous cesarean section. Methouk A retrospective study of the records of private and public hospital patients who underwent vaginal hysterectomy performed by the senior author. Two hundred twenty patients who had had previous cesarean sections were compared with a control group of 200 patients who had not had previous pelvic surgery, with special reference to operative difficulties, intraoperative complications, surgical time and length of hospital stay. Results: It was possible to perform vaginal hysterectomy safely in patients with previous cesarean sections. Three of 200 (1 .S%) patients had inadvertent intraoperative urological trauma because of dense adhesions. Conclusions: The vaginal route is the route of choice for performing a hysterectomy in patients with previous cesarean section.
The Journal of the American Association of …, 1994
We compared laparoscopic-assisted vaginal hysterectomy (LA VH) with total abdominal hysterectomy (TAH) in a case control study that evaluated length of operation, blood loss, length of hospital stay, drug requirements for pain, and postoperative pain and activity levels. Of 81 women who underwent nonradical hysterectomy for a primary diagnosis of pelvic pain between June 1 and December 31, 1992, 19 who underwent each procedure were chosen for inclusion in the study. Patients were matched in a case control manner for age, weight, diagnosis, and uterine weight. All 38 hysterectomies were completed without incident. When indicated, unilateral or bilateral oophorectomies were performed. The average surgery time for LA VH was 144 minutes and for TAH 98 minutes, a significant difference (p <0.005). There were no significant differences between estimated blood loss and change in hemoglobin from preoperative levels to postoperative day 1 levels between the groups. Women having TAH reported significantly more pain after their release from the hospital. There was no significant difference in pain during hospitalization apparently because patients who had TAH self-medicated to maintain acceptable levels. That group in fact used an average of 436 mg meperidine during their hospital stay, significantly more than the 197 mg used by the LA VH group (p <0.005). The length of stay was 2. 125 days for LA VH and 3.542 days for TAH (p <0.001). On a scale of 1 to 10 (10 being complete normal activity) the activity level of women undergoing LAVH was 9.2 by day 14 compared with 6.4 for those having TAH (p <0.005). By the sixth postoperative week the latter group reported an activity level of only 8.5, indicating that the ability to function is much more severely limited after TAH than LA VH.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 1996
To assess the feasibility of performing laparoscopically assisted vaginal hysterectomy (LAVH) on women referred for total abdominal hysterectomy (TAH). Prospective intervention study on women referred for TAH from a gynaecological outpatient clinic. Groote Schuur Hospital, Cape Town. This institution accepts patient referrals from community hospitals and family physicians for hospitalised care. Forty-one consecutive women referred for TAH were suitable for LAVH. Women able to undergo conventional vaginal hysterectomy, women with uterine fibroids exceeding 14 weeks in size and subjects with malignant disease were excluded. The most common indication for hysterectomy was persistent abnormal bleeding. Of the 41 women assessed pre-operatively as suitable for LAVH, the procedure was successfully performed in 40 by means of a bipolar desiccation and scissors transection technique with re-usable equipment. Assessment of intra-operative and postoperative morbidity, surgical complications, o...
Minimally Invasive Surgery, 2014
Background.The idea of laparoscopic assisted vaginal hysterectomy (LAVH) is to convert a potential abdominal hysterectomy to a vaginal one, thus decreasing associated morbidity and hastening recovery. We compared intraoperative and postoperative outcomes between LAVH and abdominal hysterectomy, to find out if LAVH achieves better clinical results compared with abdominal hysterectomy.Material and methods.A total of 48 women were enrolled in the study. Finally 17 patients underwent LAVH (cases) and 20 underwent abdominal hysterectomy (controls). All surgeries were performed by a set of gynecologists with more or less same level of surgical experience and expertise.Results.None of the patients in LAVH required conversion to laparotomy. Mean operating time was 30 minutes longer in LAVH group as compared to abdominal hysterectomy group (167.06+31.97 min versus 135.25+31.72 min;P<0.05). However, the mean blood loss in LAVH was 100 mL lesser than that in abdominal hysterectomy and the d...