Laparoscopy vs. laparotomy for gynecologic procedures. Impact on resident training

To compare laparoscopic approaches to traditional ones for operative procedures.

Operating residents collected data on all abdominal, vaginal and laparoscopic vaginal hysterectomies, myomectomies, cystectomies/oophorectomies and ectopics between December 1, 1992, and July 31, 1993. Statistical analysis included Student's t test for interval data and chi (2)/Fisher's exact test for categorical data.

Leiomyomas were the major indications for all three types of hysterectomy. Patients selected for vaginal hysterectomy had significantly higher parity and older age than those scheduled for abdominal hysterectomy or laparoscopically assisted vaginal hysterectomy (LAVH). Abdominal hysterectomy uteri were larger than those using vaginal or LAVH procedures. LAVH procedures were significantly longer when failed laparoscopic procedures were excluded. Abdominal hysterectomy patients used twice as much morphine as vaginal and LAVH patients, and the length of stay was longer. LAVH was significantly more expensive than vaginal hysterectomy. There was no difference in operating time for nonhysterectomy cases, but the cost and length of stay were less for laparoscopy.

Laparoscopy can be advantageous for certain procedures but has little advantage for hysterectomy and may make fewer vaginal hysterectomies available for resident education since the patients selected for LAVH and total vaginal hysterectomy are more similar to each other than to patients selected for total abdominal hysterectomy.