Assessments of laparoscopic-assisted vaginal hysterectomy

To assess laparoscopic-assisted vaginal hysterectomy (LAVH) by operative intervention, recovery time, morbidity, and patient satisfaction.

A retrospective, cohort study conducted from 1990 to 1992.

Two community hospitals.

One hundred seventy-eight women thought to require abdominal hysterectomy.

Three gynecologic surgeons performed the LAVHs. For each case, several features were tabulated and final pathologic diagnoses were recorded. Patient satisfaction was measured by survey. Data were divided into three time epochs, early, middle, and late, and the outcomes were compared. We also measured the impact of LAVH on th number of abdominal hysterectomies.

The mean operative time was 119.4 minutes (SD 34.1 min). The mean uterine weight was 153.4 g (SD 100.3 g), and only 29 patients (16.3%) had no pathologic condition. The mean length of hospital stay was 1.3 days (SD 0.92 days) and diminished over the 2 years of the study. Mean hemoglobin decrement was 2.6 g (SD 1.2 g). Thirteen patients had complications other than febrile morbidity and seven had febrile morbidity, for an overall complication rate of 11.2% There were no significant differences in blood loss, complication rate, uterine weight, or operative time among the three epochs. One hundred thirty-two patients (73.0%) responded to the survey and expressed high satisfaction. The proportion of hysterectomies performed abdominally diminished over the course of the study.

Morbidity associatd with LAVH was similar to that reported for vaginal hysterectomy. The lack of controls precludes knowing whether patient satisfaction was related to type of procedure. Randomized, controlled trials of women not considered candidates for vaginal hysterectomy are necessary to assess this procedure.