LAPAROSCOPICALLY ASSISTED VAGINAL HYSTERECTOMY

The list of gynecologic operations that can be performed by operative laparoscopy has expanded rapidly and now includes hysterectomy, yet th ere has been little critical assessment of the clinical outcome and co mplications of these procedures. This report is a retrospective review of 119 laparoscopically assisted vaginal hysterectomies (LAVHs). The most common indications were pelvic pain, menorrhagia, pelvic mass and uterine myomas. Of the 119 women, 94 (79%) had one or move factors co nsidered to be absolute ol relative contraindications to vaginal hyste rectomy. The average operating time was 79+/-3 (SEM) minutes, with an estimated blood loss of 135+/-10 mt and an average length of hospitali zation of 59+/-2 hours. Intraoperative complications were limited to v aginal entry into the bladder in one patient. Sixteen women had estima ted blood losses > 300 mL; none received a blood transfusion. To more accurately describe the laparoscopic procedure performed, a staging sy stem classifying the extent of the laparoscopic portion of the procedu re is presented. Such a system is helpful for assessing the risk/benef it ratio of LAVH. While the findings of this study suggest the potenti al advantages of LAVH, future studies will be required to determine th e specific efficacy of the procedure.