Laparoscopically Assisted Vaginal Hysterectomy (LAVH) in a Community Hospital: An Initial Experience

A total of 44 procedures were begun as LAVH with 41 (93%) completed and 3 (7%) attempted but converted to an open approach. Indications were: Leiomyata uteri, 21 (48%); menometrorrhagia, 10 (23%); Uterine prolapse, 6 (14%); endometriosis, 6 (14%); and 1 cervical carcinoma. Four complications occurred. One intraoperative large bowel perforation associated with extensive adhesions occurred and perforation was converted into an abdominal hysterectomy. The perforation was repaired primarily. The 3 remaining complications were delayed vaginal cuff bleeding, one of which required return to the operating room on post-operative day 25 for suturing of the vaginal cuff. The average length of stay was 3 days (range 2-8). The author reviewed the general experience of introducing this new procedure into a community hospital and concluded that LAVH is efficacious and can be safely introduced into a community hospital setting.