Laparoscopic assisted vaginal hysterectomy--190 cases: complications and training

Laparoscopic assisted vaginal hysterectomy continues to gain popularity worldwide without evidence from any controlled trials of its superiority over existing techniques. There is some concern over complication rates particularly damage to the urinary tract and haemorrhage. The Royal College of Obstetricians and Gynaecologists has compiled a register of preceptors for advanced laparoscopic surgery, however there is nothing to prevent a surgeon without adequate training or experience from embarking upon any form of minimal access surgery. This series consists of 190 cases performed by one surgeon in a District General Hospital over the past five years. The mean operating time was 87 minutes and the mean hospital stay 2.7 days. There were nine failures. The incidence of late urinary tract damage was 1.6% and haemorrhage requiring transfusion 3.7%. Both the complication and failure rate fell slowly with experience, implying that the surgical learning period is significantly longer than with conventional surgery. With better selection it is felt that these figures can be further improved.