CHANGING HYSTERECTOMY PATTERNS AFTER INTRODUCTION OF LAPAROSCOPICALLY ASSISTED VAGINAL HYSTERECTOMY

OBJECTIVE: The objective of this study was to determine whether introduction of laparoscopically assisted vaginal hysterectomy decreases the percentage of women requiring laparotomy for hysterectomy. STUDY DESIGN: A retrospective review of women undergoing hysterectomies from 1990 through 1992 was performed. Type of hysterectomy and total hospital charges were determined. Indication for surgery and complicatons in the laparoscopically assisted vaginal hysterectomy group were also examined. RESULTS: During the study interval 670 hysterectomies were performed. In 1990 and 1991 abdominal hysterectomies comprised 51.5% and 45.5% of all hysterectomies, respectively. After introduction of laparoscopically assisted vaginal hysterectomy in 1992 the percentage of abdominal hysterectomies declined to 35.6%, whereas the percentage of unassisted vaginal hysterectomies remained stable. The complication rate for patients with laparoscopically assisted vaginal hysterectomy was 16%. Average cost was $11,931 compared with $7031 for abdominal hysterectomy and $5343 for vaginal hysterectomy. CONCLUSION: Laparoscopically assisted vaginal hysterectomy can decrease the number of patients requiring a laparotomy for hysterectomy but at a much greater cost.