ASSESSMENTS OF LAPAROSCOPIC-ASSISTED VAGINAL HYSTERECTOMY

Study Objective. To assess laparoscopic-assisted vaginal hysterectomy (LAVH) by operative intervention, recovery time, morbidity, and patien t satisfaction. Design. A retrospective, cohort study conducted from 1 990 to 1992. Setting. Two community hospitals. Patients. One hundred s eventy-eight women thought to require abdominal hysterectomy. Interven tions. Three gynecologic surgeons performed the LAVHs. For each case, several features were tabulated and final pathologic diagnoses were re corded. Patient satisfaction was measured by survey. Data were divided into three time epochs, early, middle, and late, and the outcomes wer e compared. We also measured the impact of LAVH on the number of abdom inal hysterectomies. Measurements and Main Results. The mean operative lime was 119.4 minutes (SD 34.1 min). The mean uterine weight was 153 .4 g (SD 100.3 g), and only 29 patients (16.3%) had no pathologic cond ition. The mean length of hospital stay was 1.3 days (SD 0.92 days) an d diminished over the 2 years of the study. Mean hemoglobin decrement was 2.6 g (SD 1.2 g). Thirteen patients had complications other than f ebrile morbidity and seven had febrile morbidity, for an overall compl ication rate of 11.2%. There were no significant differences in blood loss, complication rate, uterine weight, or operative time among the t hree epochs. One hundred thirty-two patients (73.0%) responded to the survey and expressed high satisfaction. The proportion of hysterectomi es performed abdominally diminished over the course of the study. Conc lusions. Morbidity associated with LAVH was similar to that reported f or vaginal hysterectomy. The lack of controls precludes knowing whethe r patient satisfaction was related to type of procedure. Randomized, c ontrolled trials of women not considered candidates for vaginal hyster ectomy are necessary to assess this procedure.