Implications of performing laproscopic assisted vaginal hysterectomy versus abdominal hysterectomy on suitable patients in a South African hospital setting

Abstract

Objectives. To compare short-term clinical results with standard abdominal hysterectomy (AH), to investigate the feasibility of registrar training in laparoscopic-assisted vaginal hysterectomy (LAVH), and to investigate the impact of laparoscopy in changing the route of hysterectomy in women assessed as being unsuitable for vaginal hysterectomy (VH) on clinical examination. Methods. 104 women scheduled for AH for benign uterine conditions were enrolled in the study. Criteria for inclusion were uterine size ≤14-week pregnancy, width ≤9 cm and length ≤14 cm. Clinical ovarian pathology and uterine prolapse were criteria for exclusion. Patients were divided into two groups matched with respect to age, parity, previous pelvic surgery and indications for hysterectomy. Laparoscopic assessment of the pelvic organs before VH was performed in 58 of the 104 patients in the study, and 46 patients had AHs without laparoscopic assessment. Results. VH facilitated by laparoscopic assessment was successful in all cases, with no need to convert to the
abdominal route. The time required for LAVH compared with AH was longer, but not significantly so (mean 59.3 minutes v. 57.2 minutes). Blood loss was found to be less with LAVH than with AH, and postoperative pain and need for analgesia were significantly less (p<0.001). Postoperative hospital stay was significantly shorter in the LAVH group (2.4 days) than in the AH group (3.9 days) (p<0.001). Conclusions. There was shorter hospital stay, less need for analgesia, less intraoperative bleeding and better patient satisfaction with LAVH. Moreover, LAVH decreased the number of hysterectomies done abdominally.

South African Journal of Obstetrics & Gynaecology Vol. 14 (2) 2008: pp. 70-74