Comparison of classic intrafascial supracervical hysterectomy with total laparoscopic and laparoscopic-assisted vaginal hysterectomy

Study Objective. To evaluate the efficacy of laparoscopic hysterectomy and compare classic intrafascial supracervical hysterectomy (CISH) with total laparoscopic hysterectomy (TLH) and laparoscopic-assisted vaginal hysterectomy (LAVH). Design. Retrospective review (Canadian Task Force classification II-2). Setting. University-affiliated hospital. Patients. Six hundred fifty women who underwent laparoscopic hysterectomy from August 1993 to August 1996. Interventions. Charts of 231 women undergoing CISH, 102 TLH, and 317 LAVH were reviewed regarding patient characteristics, indications, uterine weight, associated procedures, estimated blood loss, operating time, and complications. Measurements and Main Results. Among the three groups, despite having the largest specimen weight and highest number of associated procedures, women undergoing CISH had the lowest complication rate and smallest amount of estimated blood loss (p <0.05). The next lowest was the TLH group (p <0.05). Although LAVH was associated with shortest operating time, there were no statistically significant differences among groups (p >0.05). The CISH group had relatively shorter operating times when compared with similar average specimen weights. Patients who underwent total hysterectomy by either TLH or LAVH had more postoperative visits than those having CISH (p <0.05 Fisher's exact test); the LAVH group had the highest number of postoperative visits. The over all complication rate appeared to be highest in the LAVH group (p <0.05 Fisher's exact test). Conclusion. Among the three groups, CISH resulted in lowest blood loss and fewest complications; these values were also lower for TLH than for LAVH. if the cervix is removed along with the uterus, TLH is recommended. In our opinion, CISH is preferred in cases of benign uterine diseases because it lowers major operative complications, especially in women who have large masses with no pathologic lesions of the cervix.