Indications of laparoscopic hysterectomy

To determine when vaginal hysterectomy is contra-indicated and abdominal hysterectomy should be performed. To assess when laparoscopic surgery can avoid the abdominal procedure, and to determine the indications of this new technique in case of benign uterine lesions without prolapse.

A retrospective study of 171 hysterectomies performed by the same surgeon for benign uterine lesions without prolapse. When possible the vaginal route was chosen and the following criteria were studied: indication for hysterectomy, previous surgery, uterine weight, duration of the procedure, intra- and post-operative bleeding, complications and recovery time. Statistical analysis was performed using the Chi2 test and the Fisher's exact test when appropriate with a level of significance of p < 0.05.

One hundred and nine vaginal (60.4%) and 62 abdominal (39.6%) hysterectomies were performed and the main indication was menometrorrhagia (respectively 97 (89%) and 49 (79%) cases). The indication for abdominal surgery was an enlarged uterus in 47 patients (76%). In 10 cases (6%) laparoscopy was indicated because of severe endometriosis, previous abdominal surgery or a suspect adnexal cyst. No complications occurred in either group. The duration of the procedure, blood loss and recovery time were lower in the vaginal group (p < 0.05).

Uterine volume limits vaginal hysterectomy, and this cannot be overcome by laparoscopic surgery. Only severe adhesions and endometriosis are more amenable to laparoscopic hysterectomy. The laparoscopic hysterectomy rate should not reasonably exceed 10 to 15%, yet is as high as 63% in some studies. Further studies are needed to determine the value of laparoscopic hysterectomy relative to the vaginal route.