Laparoscopically assisted vaginal hysterectomy

The list of gynecologic operations that can be performed by operative laparoscopy has expanded rapidly and now includes hysterectomy, yet there has been little critical assessment of the clinical outcome and complications of these procedures. This report is a retrospective review of 119 laparoscopically assisted vaginal hysterectomies (LAVHs). The most common indications were pelvic pain, menorrhagia, pelvic mass and uterine myomas. Of the 119 women, 94 (79%) had one or more factors considered to be absolute or relative contraindications to vaginal hysterectomy. The average operating time was 79 +/- 3 (SEM) minutes, with an estimated blood loss of 135 +/- 10 mL and an average length of hospitalization of 59 +/- 2 hours. Intraoperative complications were limited to vaginal entry into the bladder in one patient. Sixteen women had estimated blood losses > 300 mL; none received a blood transfusion. To more accurately describe the laparoscopic procedure performed, a staging system classifying the extent of the laparoscopic portion of the procedure is presented. Such a system is helpful for assessing the risk/benefit ratio of LAVH. While the findings of this study suggest the potential advantages of LAVH, future studies will be required to determine the specific efficacy of the procedure.