Implications of performing laproscopic assisted vaginal hysterectomy versus abdominal hysterectomy on suitable patients in a South African hospital setting
Objectives: 1) to compare short term clinical results with standard abdominal hysterectomy (AH); 2) to investigate the feasibility of registrar training in VH by laparoscopic assistance; 3) to investigate the impact of laparoscopy in changing the route of hysterectomy in women assessed as being unsuitable for VH on clinical examination. Methods: 104 women scheduled for AH for benign uterine conditions were enrolled in this study, meeting the following criteria: uterine size ≤14-week pregnancy, width ≤9cm and length ≤14cm. Clinical ovarian pathology and uterine prolapse were exclusion criteria. Patients were divided in 2 groups matched with respect to age, parity, previous pelvic surgery and indications for hysterectomy. Prior to VH laparoscopic assessment of pelvic organs was performed for 58 of the 104 patients in this study, 46 of these patients had abdominal hysterectomies without laparoscopic assessment.
Results: All cases allocated to have VH facilitated by laparoscopic assessment were successful. There was no need to convert to the abdominal route. Required time for LAVH compared to AH was longer, but not significantly so (mean 59.3 min. vs. 57.2 min.). Blood loss was found to be less with LAVH. Postoperative pain and need for analgesia was significantly less in LAVH as compared to AH (P<0.001). The postoperative hospital stay was significantly shorter in the LAVH group (2.4 days) as compared to AH (3.9 days); P<0.001.
Conclusion: There was shorter hospital stay, less need for analgesia, less intraoperative bleeding, and better patient satisfaction with LAVH. Moreover, it decreased the number of hysterectomies done abdominally.
Andreas Chrysostomou, Doctor
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Date published: 2008-10-30
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