THE MEDICAL AND ECONOMIC-IMPACT OF LAPAROSCOPICALLY ASSISTED VAGINAL HYSTERECTOMY IN A LARGE, METROPOLITAN, NOT-FOR-PROFIT HOSPITAL

OBJECTIVE: Our purpose was to evaluate the medical and economic impact of operative laparoscopy on the surgical approach to hysterectomy for benign disease in a large, metropolitan, not-for-profit hospital. STU DY DESIGN: Retrospective analyses were performed on 2563 hysterectomie s (without vaginal or bladder repair) for benign disease, performed by 37 gynecologists between January 1991 and December 1993. Disposable l aparoscopic instruments and stapling devices were not used at any time during the study period. Electrosurgery and sutures were used for hem ostasis. Parameters analyzed included surgical approach (total abdomin al hysterectomy, vaginal hysterectomy, laparoscopically assisted vagin al hysterectomy, and failed laparoscopically assisted vaginal hysterec tomy), operative time, postoperative diagnosis, operative blood loss, length of stay, complications, uterine weight, and hospital charges. C harges in each of these parameters were analyzed and compared in 6-mon th increments. RESULTS: During the study period the percent of hystere ctomies performed abdominally declined from 65% to 36%. Laparoscopical ly assisted vaginal hysterectomy increased from 12% to 45%, and vagina l hysterectomy varied from 23% to 19%. Average operative time was 82 m inutes (+/-2 minutes) for total abdominal hysterectomy, 102 minutes (/-2.3 minutes) for laparoscopically assisted vaginal hysterectomy, and 63 minutes (+/-2 minutes) for vaginal hysterectomy. Hospital stay was 68 hours (+/-1.5 hours) for total abdominal hysterectomy, 44 hours (/-1.2 hours) for laparoscopically assisted vaginal hysterectomy, and 4 3 hours (+/-4.1 hours) for vaginal hysterectomy. The average hospital charge was $6552 (+/-$108) for total abdominal hysterectomy, $6431 (+/ -$100) for laparoscopically assisted vaginal hysterectomy, and $5869 ( +/-$116) for vaginal hysterectomy. CONCLUSIONS: Contrary to previously published studies, our study demonstrates (1) laparoscopically assist ed vaginal hysterectomy is a cost-effective procedure when performed w ith reusable instruments, (2) laparoscopically assisted vaginal hyster ectomy is a safe procedure, even when performed by a variety of gyneco logists with different skill levels, and (3) the number of hysterectom ies performed abdominally was decreased by 29% without incurring more complications or reducing the number of vaginal cases.