JOURNAL
OF LAPAROENDOSCOPIC SURGERY
Volume 4, Number 3, 1994
Mary Ann Liebert, Inc., Publishers
Laparoscopically
Assisted Vaginal Hysterectomy Appears to Be an Alternative to Total
Abdominal Hysterectomy
J.D. ARBOGAST, M.D.,¹ R.A. WELCH, M.D.,¹
E. D. RIZA, M.D.,³ E. L. RICAURTE, M.D.,³ and D.R. PIEPER,
Ph. D.²
ABSTRACT
Seventy percent
of hysterectomies in the United States are performed as total abdominal
hysterectomies (TAH). Laparoscopic assisted vaginal hysterectomy (LAVH)
has been promoted by some to be a low morbidity substitute for TAH.
In this study, we compared the outcomes of 61 recent LAVH cases to
65 TAH cases performed during an earlier time interval. Data were
abstracted from the charts of 65 TAH cases performed between August
1988 and December 1990 and 61 LAVH cases performed between June 1991
and September 1992 by the same gynecologist (E.D.R.). Patient characteristics
and perioperative morbidities were compared. Patient characteristics
were similar between the two groups except that LAVH procedures were
performed on thinner women (148 ± 3.4 vs 162 ± 4.3 lbs,
p =< 0.01, LAVH vs TAH) and operating time was
longer (137 ± vs 66 ± 1.7 min, p =< 0.0001).
Uterine weights were comparable (152 ± 12 vs 194 ± 31
g, p = 0.2). There was less intraoperative blood loss
(337 ± 21 vs 417 ± 16 ml, p =< 0.003),
febrile morbidity (9.8 vs 66 %, p =< 0.0001),
respiratory complications (6.6 vs 22 %, p =<
0.05), urinary morbidity (6.6 vs 24.4%, p =<
0.02) and shorter postoperative hospitalization (22 ±
1.2 vs 99 ± 2.3 h, p =< 0.0001) in the LAVH
group. Thinner patients were selected for the LAVH procedure, and
operating room time was twice that of those undergoing TAH. Conversely,
perioperative morbidity and postoperative hospitalization time were
significantly less with LAVH. LAVH appears to be an alternative to
TAH.
Department
of ¹ Obstetrics & Gynecology and ²Physiology, Providence
Hospital, Southfield, Michigan.
³Department of Obstetrics & Gynecology, St. Charles Hospital,
Toledo, Ohio. Address
reprint requests to:
Robert A. Welch, M. D.
Department of Obstetrics & Gynecology
Providence Hospital
16001 West Nine Mile Road
Southfield, MI 48037
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