CHANGING TRENDS IN SURGICAL APPROACHES TO HYSTERECTOMY - AN ANALYSIS OF THE USE OF LAPAROSCOPIC ASSISTED VAGINAL HYSTERECTOMIES IN CLINIC PRACTICE

Our previous analysis of the applications and morbidities of the first 115 laparoscopic assisted vaginal hysterectomies (LAVH) performed bet ween October 1990 and February 1993 by faculty gynecologic surgeons in three local hospitals compared with vaginal hysterectomies (VH) and a bdominal hysterectomies (AH) during the same period showed low morbidi ty with LAVH and led us to recommend that this procedure should be use d in some cases that might otherwise be approached with AH. Since this initial experience, LAVH has become a more commonly used procedure in the clinical practices of our affiliated faculty, while simultaneousl y, we have seen a concomitant decline in the number and proportion of VH performed by affiliated faculty surgeons (p<0.0001). The present in vestigation of 114 LAVH performed between July 1, 1993, and June 30, 1 994, demonstrated through bivariate analysis and matched LAVH/VH and L AVH/AH case control studies that LAVH were accomplished with low morbi dity and short operative times and lengths of hospital stays compared with VH and AH. A logistic regression model based on data from hystere ctomies done between July 1, 1989, and June 30, 1990, before the intro duction of LAVH, showed that 69.4% of the LAVH performed in 1993-1994 were more likely than VH cases to meet the criteria for AH (p<0.0001). It is concluded that LAVH performed by faculty surgeons in 1993-1994 were done more frequently for cases that would have been selected for AH than for VH in 1989-1990.