Prospective randomized comparison of laparoscopic-assisted vaginal hysterectomy (LAVH) with abdominal hysterectomy (AH) for the treatment of the uterus weighing >200 g

Background: Laparoscopic-assisted vaginal hysterectomy (LAVH) can be used for the vaginal removal of large uteri (200 g), which are conventionally treated with an abdominal approach (AH). Methods: Forty-eight women with a sonographically estimated uterine weight of >200 g were prospectively randomized to undergo either LAVH (n = 28) or AH (n = 20). Results: The median uterus weight was 334 g for LAVH vs 428 g for AH (not significant). The median operative time (133 vs 132 min) and duration of recuperation (42 vs 42 days) were similar. LAVH was associated with significantly less intraoperative blood loss (median, 200 vs 600 ml; p < 0.05), a lower pain index at postoperative day 4 (median [WHO scale], 0 vs 5; p < 0.05), a lower decrease in hemoglobin (median, -0.6 vs -1.55 mg/dl; p < 0.05), and a lower decrease in hematocrit (median, -0.03% vs -0.07% p < 0.05). There were no significant differences in the frequency of postoperative complications (14.3% for LAVH vs 30% for AH). Although all LAVH patients who answered the questionnaire said they would undergo the same procedure again, only 45% of the AH group were satisfied (p < 0.05). Conclusion: For the treatment of uteri >200 g, LAVH has several advantages over AH: lower postoperative morbidity, quicker short-term recuperation, and better patient acceptance.