Continuing Experience with Laparoscopically Assisted Vaginal Hysterectomy in a Private Teaching Community Hospital

This study compares our first and second years' experience in performing laparoscopically assisted vaginal hysterectomy (LAVH). During our second year, 42 LAVH's were performed by 20 different surgeons compared with 49 LAVH's performed by 25 different surgeons during the first year. Ten new surgeons attempted the procedure in the second year, three of whom had assisted in the previous year. The remainder were assisted by experienced surgeons from the first year's group. Of the 17 assistant surgeons, 12 had been surgeons or assistants the previous year. The patient cohorts did not differ statistically in age, gravity, parity, or indications for surgery. Although the overall rate of complications was not statistically different, two patients in the second year group required subsequent laparotomy, one to repair a bladder laceration and one for intraabdominal bleeding from an incompletely ligated uterine artery. Both surgeons were among the five most experienced in the total group. There were no statistical differences in hematocrit drop, transfusion rate, febrile morbidity, uterine weights or length of hospital stay. The operative times were 161±92 minutes in the first year and 154±88 minutes in the second year. We conclude that LAVH may continue to be safely introduced into a community hospital setting but that more complications may be expected as surgeons gain experience and attempt more difficult cases.