LAPAROSCOPICALLY ASSISTED VAGINAL HYSTERECTOMY FOR NONMALIGNANT DISEASE OF THE UTERUS - REPORT ON A PERSONAL SERIES OF 126 CASES

Objective: A report is given of a series of 126 laparoscopically-assis ted vaginal hysterectomies (LAVH) for benign lesions, carried out betw een September 1990 and December 1995. Materials and method: The mean a ge of the patients was 50.3 years, and the main indications for hyster ectomy were metrorrhagia (88). The main reasons why LAVH was chosen fr om among other hysterectomy techniques were a large uterus (55), assoc iated ovarian surgery (45), and a difficult vaginal approach (35). The surgical technique always began with a laparoscopic stage followed by a vaginal stage. The laparoscopic stage generally finished at the low er part of the broad ligament. The vagina was opened and the uterine a rteries were ligatured by a vaginal approach (116). Only 10 total lapa roscopic hysterectomies were performed. Results: The mean duration of the operation was 72+/-28 min, mean blood loss was 1.89 g/dl, and mean uterus weight was 224 g (maximum=1093 g). Operative complications con sisted of two bladder wounds and two switches to abdominal hysterectom y. Postoperative complications were urinary infections (17), hemorrhag es needing second-look operations [2] and abscess of the vaginal secti on; requiring evacuation [3]. Conclusion: LAVH should never be carried out instead of vaginal hysterectomy (VH), since VH is the best proced ure when it is easy to perform. The authors use LAVH when VH is diffic ult or contraindicated (the aim being to avoid laparotomy) and actuall y carry out less than 5% of hysterectomies for benign lesions by lapar otomy.