A MULTICENTER RANDOMIZED COMPARISON OF LAPAROSCOPICALLY ASSISTED VAGINAL HYSTERECTOMY AND ABDOMINAL HYSTERECTOMY IN ABDOMINAL HYSTERECTOMY CANDIDATES

Objective: To compare intraoperative and postoperative outcomes betwee n laparoscopically assisted vaginal hysterectomy and abdominal hystere ctomy among patients who are not eligible for vaginal hysterectomy. Me thods: Study subjects were randomly assigned to undergo laparoscopical ly assisted vaginal hysterectomy or standard abdominal hysterectomy. I ntraoperative and post-operative management was similar for each group . Surgical characteristics, complications, length of hospital stay, ch arges, and convalescence were analyzed. Results: Sixty-five women at t hree institutions underwent laparoscopically assisted vaginal hysterec tomy (n = 34) or abdominal hysterectomy (n = 31). Three patients in th e laparoscopic group required conversion to abdominal hysterectomy. Me an operating time was significantly longer for laparoscopically assist ed vaginal hysterectomy (179.8 versus 146.0 minutes). There were no di fferences in blood loss or incidence of intraoperative complications. There was a higher incidence of wound complications in the abdominal h ysterectomy group, but no significant difference in the frequency of p ostoperative complications. Laparoscopically assisted vaginal hysterec tomy required a significantly shorter mean hospital stay (2.1 days) an d convalescence (28.0 days) than abdominal hysterectomy (4.1 days and 38.0 days, respectively). There were no significant differences in mea n hospital charges between the study groups (laparoscopic $8161, abdom inal $6974). Conclusion: Except for operating time, there are no diffe rences between laparoscopically assisted vaginal hysterectomy and abdo minal hysterectomy regarding intraoperative characteristics among abdo minal hysterectomy candidates. Postoperatively, laparoscopically assis ted vaginal hysterectomy requires a shorter hospital stay and convales cence. Hospital charges are similar between the procedures. A larger n umber of cases will help determine the indications for laparoscopicall y assisted vaginal hysterectomy. (Obstet Gynecol 1998;92:321-6. (C) 19 98 by The American College of Obstetricians and Gynecologists.).