Laparoscopic hysterectomy

Study Objective. To determine the soundness of laparoscopic hysterectomy co mpared with vaginal and abdominal hysterectomy Design. Nonrandomized, uncontrolled, retrospective study (Canadian Task For ce classification III). Setting. Medium-size community hospitals. Patients. One thousand six hundred forty-eight women undergoing laparoscopi c hysterectomy including those with uterine size 17 weeks' gestation or les s. Intervention. Laparoscopic hysterectomy staged as level 4, which includes l aparoscopic dissection of the uterine artery. Measurements and Main Results. The median duration of surgery was 36 minute s (range 24-104 min), compared with the usual 115 minutes for laparoscopic- assisted vaginal hysterectomy. Complication rate was 0.66%. No complication s occurred in the last 3 years when the procedures included transilluminati on of the ureters. Although the costs associated with disposable equipment are high, the technique is cost effective. Conclusion. With proper training and ureteral transillumination, laparoscop ic hysterectomy is safe and effective, and with stents, ureteral injury is avoided.