LAPAROSCOPY-ASSISTED HYSTERECTOMY - A SER IES OF 177 CASES

Our objective was to determine the limits of laparoscopic-assisted vag inal hysterectomy (LAVH) and the value of a preoperative scoring syste m to determine the operative approach to hysterectomy. Between January 1991 and December 1996, 152 out of 177 patients had LAVH and 25 had l aparoconversion. The mean operating time was 163 min. The overall post operative complication rate was 8.4%. The hospital stay was 4.8 days f or LAVH versus 6.2 days for laparoconversion (p<0.01). For each patien t, a preoperative scoring system was established according to uterine size, previous laparotomy, uterine mobility, pelvic adhesions and endo metriosis stage. The laparoconversion rate increased according to the score, as it was 7.8% for a score less than or equal to 7 and 80% for a score > 7. LAVH offers a technique to convert some abdominal hystere ctomies into vaginal hysterectomies. The use of the preoperative scori ng system may help to determine patients who may benefit from the lapa roscopic route and those with a high risk of laparoconversion.