Frequency and cause of aborted laparoscopic-assisted vaginal hysterectomy

Study Objective. To evaluate the frequency and cause oi aborted laparoscopic-assisted vaginal hysterectomies (LAVH) at two hospitals of a major obstetrics and gynecology training program. Design. Retrospective cohort study. Setting. A university hospital and a university-affiliated county hospital. Patients. Seventy-eight consecutive women who underwent LAVH at our institutions between June 1992 and February 1995. Interventions. Data on age, weight, indications for surgery, obstetric and surgical history, concomitant procedures performed, postoperative diagnosis, perioperative complications, operative time, estimated blood loss, uterine weight, and length of hospital stay were collected from patients' hospital records. Univariate analysis oi variance to assess statistical significance was performed when appropriate. Measurements and Main Results. Eight (11.7%) of 78 procedures were converted to abdominal hysterectomy. The most frequent reason for conversion 15 cases, 6%) was large uterine size with limited mobility and associated inability to visualize the pelvic sidewall structures adequately. The other three procedures were converted because of massive intraperitoneal adhesions (2) and intraoperative severe bleeding (1). The mean uterine weight oi these eight women (575 g, range 387-1030 g) was significantly higher than that of patients undergoing successful LAVH (230 g, range 35-612; p <0.03). Conclusions. In our limited series of 78 patients, only one LAVH was converted to abdominal hysterectomy because of an intraoperative complication. A conversion rate of 11.1% may be appropriate so as to offer the potential benefits of the laparoscopic-assisted vaginal approach to the largest number of women who would otherwise undergo an abdominal hysterectomy.