INDICATIONS OF LAPAROSCOPIC HYSTERECTOMY

Objective: To determine when vaginal hysterectomy is contra-indicated and abdominal hysterectomy should be performed. To assess when laparos copic surgery can avoid the abdominal procedure, and to determine the indications of this new technique in case of benign uterine lesions wi thout prolapse. Materials and methods: A retrospective study of 171 hy sterectomies performed by the same surgeon for benign uterine lesions without prolapse. When possible the vaginal route was chosen and the f ollowing criteria were studied: indication for hysterectomy, previous surgery, uterine weight, duration of the procedure, intra- and post-op erative bleeding, complications and recovery time. Statistical analysi s was performed using the Chi(2) test and the Fisher's exact test when appropriate with a level of significance of p<0.05. Results: One hund red and nine vaginal (60.4%) and 62 abdominal (39.6%) hysterectomies w ere performed and the main indication was menometrorrhagia (respective ly 97 (89%) and 49 (79%) cases). The indication for abdominal surgery was an enlarged uterus in 47 patients (76%). In 10 cases (6%) laparosc opy was indicated because of severe endometriosis, previous abdominal surgery or a suspect adnexal cyst. No complications occurred in either group. The duration of the procedure, blood loss and recovery time we re lower in the vaginal group (p<0.05). Comments: Uterine volume limit s vaginal hysterectomy, and this cannot be overcome by laparoscopic su rgery. Only severe adhesions and endometriosis are more amenable to la paroscopic hysterectomy. The laparoscopic hysterectomy rate should not reasonably exceed 10 to 15%, yet is as high as 63% in some studies. F urther studies are needed to determine the value of laparoscopic hyste rectomy relative to the vaginal route. (C) 1997 Elsevier Science Irela nd Ltd.