Laparoscopically assisted vaginal hysterectomy (LAVH)--an alternative to total abdominal hysterectomy (original) (raw)
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South African Medical Journal, 2008
Objectives: 1) to compare short term clinical results with standard abdominal hysterectomy (AH); 2) to investigate the feasibility of registrar training in VH by laparoscopic assistance; 3) to investigate the impact of laparoscopy in changing the route of hysterectomy in women assessed as being unsuitable for VH on clinical examination. Methods: 104 women scheduled for AH for benign uterine conditions were enrolled in this study, meeting the following criteria: uterine size ≤14-week pregnancy, width ≤9cm and length ≤14cm. Clinical ovarian pathology and uterine prolapse were exclusion criteria. Patients were divided in 2 groups matched with respect to age, parity, previous pelvic surgery and indications for hysterectomy. Prior to VH laparoscopic assessment of pelvic organs was performed for 58 of the 104 patients in this study, 46 of these patients had abdominal hysterectomies without laparoscopic assessment. Results: All cases allocated to have VH facilitated by laparoscopic assessm...
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...
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.
Journal of Gynecologic Surgery, 1994
The first 115 laparoscopically assisted vaginal hysterectomies (LAVH) done by our faculty surgeons were compared with 220 vaginal hysterectomies (VH) and 194 abdominal hysterectomies (AH) done in our affiliated hospitals over the same period of time. Logistic regression analysis indicates that LAVHs were done for cases that would significantly be more likely selected for AH than for VH (p < 0.0001). Matched case control studies with 28 LAVH/VH and 34 LAVH/AH pairs and bivariate analyses demonstrated that LAVH can be accomplished with low morbidity, short lengths of stay, and little, if any, increase in operating times compared with VH and AH. The LAVH procedure can be expected to replace many AHs in the future.
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...
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.
BMJ, 2004
Objective To compare the effects of laparoscopic hysterectomy and abdominal hysterectomy in the abdominal trial, and laparoscopic hysterectomy and vaginal hysterectomy in the vaginal trial. Design Two parallel, multicentre, randomised trials. Setting 28 UK centres and two South African centres. Participants 1380 women were recruited; 1346 had surgery; 937 were followed up at one year. Primary outcome Rate of major complications. Results In the abdominal trial laparoscopic hysterectomy was associated with a higher rate of major complications than abdominal hysterectomy (11.1% v 6.2%, P = 0.02; difference 4.9%, 95% confidence interval 0.9% to 9.1%) and the number needed to treat to harm was 20. Laparoscopic hysterectomy also took longer to perform (84 minutes v 50 minutes) but was less painful (visual analogue scale 3.51 v 3.88, P = 0.01) and resulted in a shorter stay in hospital after the operation (3 days v 4 days). Six weeks after the operation, laparoscopic hysterectomy was associated with less pain and better quality of life than abdominal hysterectomy (SF-12, body image scale, and sexual activity questionnaires). In the vaginal trial we found no evidence of a difference in major complication rates between laparoscopic hysterectomy and vaginal hysterectomy (9.8% v 9.5%, P = 0.92; difference 0.3%, − 5.2% to 5.8%), and the number needed to treat to harm was 333. We found no evidence of other differences between laparoscopic hysterectomy and vaginal hysterectomy except that laparoscopic hysterectomy took longer to perform (72 minutes v 39 minutes) and was associated with a higher rate of detecting unexpected pathology (16.4% v 4.8%, P = < 0.01). However, this trial was underpowered. Conclusions Laparoscopic hysterectomy was associated with a significantly higher rate of major complications than abdominal hysterectomy. It also took longer to perform but was associated with less pain, quicker recovery, and better short term quality of life. The trial comparing vaginal hysterectomy with laparoscopic hysterectomy was underpowered and is inconclusive on the rate of major complications; however, vaginal hysterectomy took less time.
Total Laparoscopic versus Vaginal Hysterectomy: The experience of a Training Hospital
Polish Gynaecology, 2016
Objective: To compare the operative outcomes of total laparoscopic hysterectomy (TLH) and vaginal hysterectomy (VH) in a training and research hospital. Material and Methods: Retrospective data analysis of all women who underwent either TLH or VH at gynecology unit for benign pathologies between January, 2012 and June, 2015 were conducted. Hysterectomies for desensus uteri were excluded. Groups were compared regarding operation time, change in hemoglobin value, intraoperative complications, postoperative complications and length of hospital stay. Results: During the study period, 120 patients underwent TLH and 192 patients underwent VH. Indications for surgery except desensus uteri were myomas (n= 55), endometrial hyperplasia (n= 43), dysfunctional uterine bleeding (n= 37), adenomyosis with chronic pelvic pain (n= 13), and adnexal mass (n=6). Operation time was shorter for VH in comparison with TLH (108 ± 38.3 minutes versus 151 ± 41.5; p < 0.001). Delta hemoglobin was smaller for TLH in comparison with VH (1.7 ± 0.98 versus 2.8 ± 1.03; p < 0.001). Intraoperative complications and postoperative complications were comparable (p = 0.16 and p= 0.25; respectively). Postoperative hospital stay was shorter in TLH group compared to VH group (p < 0.001). Conclusion: Although VH is the suggested approach for the removal of uterus in literature, this study showed the non-inferiority of TLH against VH.
Archives of Gynecology and Obstetrics
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). Materials and methods Ninety women with benign disease of uterus with failed medical management or not amenable to medical management were randomised into three groups for either technique of hysterectomy, thirty in each group, by the same surgeon. For each patient, intra-operative parameters including total duration of surgery, blood loss, surgical difficulty and intra-operative complications were recorded. Total hospital stay, adverse events, satisfaction rate and recuperation time was analysed and compared. Statistical analysis was done using SPSS15 software. Results Non-descent vaginal hysterectomy (NDVH) took least operative time and significantly lesser blood loss (p = 0.02) compared to TLH and LAVH. There was no significant difference between adverse events, recuperation time and postoperative pain between the three techniques. Conclusions Non-descent vaginal hysterectomy may be a preferred technique over laparoscopic hysterectomy for benign diseases of uterus where extensive pelvic dissection is not required.
Replacement of Abdominal Hysterectomy by the Laparovaginal Technique – Its Success and Limitations
The Australian and New Zealand Journal of Obstetrics and Gynaecology, 1994
The objective of this study was to study the effect of replacing of most abdominal hysterectomies with the laparovaginal technique. Three gynaecologists trained in advanced operative laparoscopy performed 160 laparovaginal, open and vaginal hysterectomies in 3 private hospitals in Melbourne. One hundred and twenty seven (79.4%) of hysterectomies were laparovaginal, 16 (10.0%) were open and 17 (10.7%) were vaginal. The distribution of technique was similar for the 3 surgeons. The high incidence of laparovaginal hysterectomy was partly due to the ability to remove uteri up to the size of a 16-week pregnancy, to divide severe pelvic adhesions and to perform recto-vaginal excisional surgery in severe endometriosis. Abdominal hysterectomy was preferred for patients with uteri larger than a 16-week pregnant size, tough intestinal adhesions, multiple pelvic pathology requiring prolonged surgery or with excessive obesity. The infrequent use of vaginal hysterectomy was related to the low occurrence of vaginal prolapse, the routine use of endometrial ablation for the treatment of menorrhagia resistant to drug therapy in uteri less than 10 cm, and the preference for laparoscopic rather than vaginal removal of the ovaries. The considered advantages of laparovaginal hysterectomy compared to abdominal hysterectomy were the reduced time in hospital and reduced convalescence. The cost of laparovaginal hysterectomy in the present study is $600-700 higher than abdominal hysterectomy. The cost may be reduced by decreased use of disposable equipment or by earlier discharge of patients from hospital. Gasless laparoscopy facilitating a combined abdominal and vaginal technique using 2 surgeons may further