[The significance of laparoscopically-assisted vaginal hysterectomy--LAVH]

The truly minimal invasive surgeon should always act to the benefit of the patient. Since most of the operative steps of hysterectomy can be performed faster and often better via the vaginal approach than through trocars, minimal invasive surgery does not necessarily mean the employment of endoscopic techniques. Simple vaginal hysterectomy continues to be the least invasive method and 60% of all uteri can be removed this way. If vaginal hysterectomy is not feasible, LAVH should be applied since of all variations of endoscopic hysterectomy. LAVH is the one with the least complications, it is not time-consuming and it is easy to learn. The most effective strategy during the laparoscopic part of LAVH is: As much as necessary--as little as possible. This means, if endoscopic operative steps do not prove to be inevitable during diagnostic laparoscopy, they should be renounced in favour of vaginal hysterectomy (LAVH type I). LAVH type I is the method of choice for about 10% of all uteri. 70% of all uteri can be removed by exclusively vaginal operation if vaginal hysterectomy and LAVH type I are taken together. If operative laparoscopy is unavoidable, is should be limited to those steps which can not be accomplished transvaginally. Another 20% of all uteri can be removed without laparotomy if LAVH type II--LAVH with operative laparoscopy--is employed. If this concept is pursued consequently, only less than 10% of all benign hysterectomies have to be performed via laparotomy.