LAPAROSCOPICALLY ASSISTED VAGINAL HYSTERECTOMY APPEARS TO BE AN ALTERNATIVE TO TOTAL ABDOMINAL HYSTERECTOMY

Seventy percent of hysterectomies in the United States are performed as total abdominal hysterectomies (TAH). Laparoscopic assisted vaginal hysterectomy (LAVH) has been promoted by some to be a low morbidity substitute for TAH. In this study, we compared the outcomes of 61 recent LAVH cases to 65 TAH cases performed during an earlier time interval. Data were abstracted from the charts of 65 TAH cases performed between August 1988 and December 1990 and 61 LAVH cases performed between June 1991 and September 1992 by the same gynecologist (E.D.R.). Patient characteristics and perioperative morbidities were compared. Patient characteristics were similar between the two groups except that LAVH procedures were performed on thinner women (148+/-3.4 vs 162+/-4.3 lbs,p less than or equal to 0.01, LAVH vs TAH) and operating time was longer (137+/-4.1 vs 66+/-1.7 min,p less than or equal to 0.0001). Uterine weights were comparable (152+/-12 vs 194+/-31 g,p=0.2). There was less intraoperative blood loss (337+/-21 vs 417+/-16 ml,p less than or equal to 0.003), febrile morbidity (9.8 vs 66%,p less than or equal to 0.0001), respiratory complications (6.6 vs 22%,p less than or equal to 0.05), and urinary morbidity (6.6 vs 24.4 %,p less than or equal to 0.02) and shorter postoperative hospitalization (22+/-1.2 vs 99+/-2.3 h,p less than or equal to 0.0001) in the LAVH group. Thinner patients were selected for the LAVH procedure, and operating room time was twice that of those undergoing TAH. Conversely, perioperative morbidity and postoperative hospitalization time were significantly less with LAVH. LAVH appears to be an alternative to TAH.