A COMPARISON OF LAPAROSCOPICALLY ASSISTED VAGINAL HYSTERECTOMY VS TRADITIONAL TOTAL ABDOMINAL AND VAGINAL HYSTERECTOMIES

The objective of this work was to compare laparoscopically assisted va ginal hysterectomy to traditional total abdominal and vaginal hysterec tomies in seven critical areas: anesthesia time, surgery time, hospita l stay, operative blood loss, total analgesic use, time required to re turn to work, and total cost of each of these procedures. The first 25 unscreened, consecutive laparoscopically assisted vaginal hysterectom ies performed by the senior author were compared with 25 randomly sele cted traditional total abdominal and 25 randomly selected vaginal hyst erectomies performed by the senior author's professional corporation. Laparoscopically assisted vaginal hysterectomy compared favorably to a bdominal and vaginal hysterectomy in three areas and was superior to b oth total abdominal hysterectomy and vaginal hysterectomy in the remai ning four areas. Although the use of the endoscopic stapling device an d laser made the laparoscopically assisted vaginal hysterectomy a more expensive procedure than traditional vaginal hysterectomy, the expens e was not significant and was justified by the decreased surgery time. The results of this comparative study suggest that laparoscopically a ssisted vaginal hysterectomy is superior or comparable to total abdomi nal hysterectomy and vaginal hysterectomy, especially for patients who may not have been candidates for vaginal hysterectomy. This procedure has allowed the gynecologic endoscopic surgeon to convert abdominal t o vaginal procedures. Laparoscopically assisted vaginal hysterectomy p rovides an overall cost savings to the patient, has a low complication rate, adapts well to the outpatient setting, causes less patient disc omfort, and allows the patient to return rapidly to home and workplace .