Prospective randomized clinical trial of laparoscopically assisted vaginalhysterectomy versus total abdominal hysterectomy

OBJECTIVE: We compared operative time, length of hospital stay, postoperati ve recovery, return to work, and costs for women undergoing laparoscopicall y assisted vaginal hysterectomy or abdominal hysterectomy. STUDY DESIGN: A prospective randomized clinical trial of laparoscopically a ssisted vaginal hysterectomy (n = 24) versus abdominal hysterectomy (n = 24 ) was carried out in a tertiary care setting. The main outcome variables we re operative time, length of hospital stay, and return to work. Secondary o utcomes were postoperative pain and return to normal activity as determined by weekly visual analog scales and daily diary. Hospital costs were calcul ated. RESULTS: The laparoscopically assisted vaginal hysterectomy group had longe r operative times (median and quartiles, laparoscopically assisted vaginal hysterectomy 180 [139, 225] minutes vs abdominal hysterectomy 130 [97, 155] minutes), lower requirements for postoperative intravenous analgesia (pati ent-controlled analgesia pump, median and quartiles: laparoscopically assis ted vaginal hysterectomy 22.1 [15.9, 23.5] hours, abdominal hysterectomy 36 .7 [26.2, 45.0] hours), shorter length of hospital stay (median and quartil es, laparoscopically assisted vaginal hysterectomy 1.5 [1.0, 2.3] days, abd ominal hysterectomy 2.5 [1.5, 2.5] days), and quicker return to work (Kapla n-Meier analysis, P = .03). Both procedures had similar hospital costs (P = .21). CONCLUSION: Laparoscopically assisted vaginal hysterectomy appears to allow patients a more rapid postoperative recovery and an earlier return to work with hospital costs similar to those of abdominal hysterectomy.