A comparison of laparoscopic supracervical hysterectomy vs laparoscopically assisted vaginal hysterectomy

Background: We set out to compare the length of stay, costs, and morbidity associated with laparoscopic supracervical hysterectomy (LSH) with laparosc opically assisted vaginal hysterectomy (LAVH). Methods: We performed a cohort analysis of consecutive patients at a univer sity-based medical center from April 1997 through October 1999. Results: A total of 145 patients were identified initially; however, 13 cas es were excluded because of concomitant procedures (retropubic urethropexy, lymphadenectomy, paravaginal repair). Of the 132 patients included in the study, 27 underwent LSH and 105 underwent LAVH. The two groups were similar with respect to gravidity, parity, uterine weight, and preoperative diagno sis. Patients undergoing LSH had significantly shorter operating times (med ian, 181 vs 220 min, p = 0.007), briefer hospital stays (median, 1.0 vs 2.0 days, p = 0.0001), and less blood loss (median, 125 vs 400 ml, p = 0.0001) . None of the patients submitted to LSH experienced morbidity, as compared with a 13% morbidity rate for LAVH (bladder injury, n = 3; blood loss >1000 ml, n = 7; vaginal cuff hematoma, n = 4; 0% vs 13%; p = 0.04). Conclusions: Patients undergoing laparoscopic supracervical hysterectomy ha d shorter operating times, shorter hospital stays, and less morbidity than those who underwent laparoscopically assisted vaginal hysterectomy. The pra ctice of routine cervicectomy at laparoscopic hysterectomy should be recons idered.