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PubMed1996

Comparison of laparoscopically assisted vaginal hysterectomy with abdominal and vaginal hysterectomy.

OBJECTIVE: To define the advantages and disadvantages of laparoscopically assisted vaginal hysterectomy (LAVH). STUDY DESIGN: The first 70 cases of LAVH performed in a community hospital were compared with 70 cases of abdominal and 70 cases of vaginal hysterectomy performed by the same physicians during the same period. RESULTS: The mean operating time was 80 minutes for LAVH, 50 for abdominal hysterectomy and 40 for vaginal hysterectomy. The incidence of complications was low for all groups. Although the total mean hospital charges were higher with LAVH, those patients required the least postoperative analgesia, resumed a regular diet earlier, required the shortest hospital stay, and returned to regular activity and work earlier than the other two groups. CONCLUSION: LAVH offers specific benefits for properly selected patients.

Adult↗

PubMed1996

Comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy in taiwan.

In order to clarify the feasibility of laparoscopically assisted vaginal hysterectomy (LAVH) using a not-for-extra charge instrument and to determine its cost-effectiveness in the Taiwan national health care system, we designed a prospective comparison which recruited candidates with nonmalignant uterine tumors prepared for hysterectomy to assess treatment by the laparoscopic versus the laparotomic approach. There were 144 patients in the laparoscopic group and 157 patients in the laparotomic group. The two groups were similar in characteristics. A total of 138 LAVHs were completed with six conversions (4.2%) to abdominal hysterectomy. Intraoperatively, the mean operating time in the LAVH group was longer than in the laparotomic group (134 vs 112 minutes, p < 0.001). No statistically significant differences were found between the two groups in mean estimated blood loss (260 vs 259 mL) and complications (5.8 vs 4.5%). Postoperatively, mean flatulence-relief time (27.4 vs 31.3 hours) and intramuscular meperidine requirements (1.6 vs 2.5 ampoules, 1 ampoule = 50 mg) were significantly less with LAVH. There were no differences in mean hemoglobin levels (10.7 vs 10.9 g/dL), complications (9.4 vs 13.4%, p = 0.288), or hospital stay (4.9 vs 5.2 days, p = 0.058). The mean total hospital charges (NT$48,390 vs 41,649) and insurance-paid costs (NT$43,992 vs 38,389) were significantly greater in the LAVH group. In conclusion, LAVH when performed by an experienced laparoscopist and for adequately selected patients, permits a better short-term convalescence, but is more expensive compared with conventional abdominal hysterectomy.

Adult↗

PubMed1997

[Vaginal hysterectomy assisted by laparoscopy. Critical and comparative study if vaginal and abdominal hysterectomy at the A.B.C. Hospital of Mexico].

The laparoscopically assisted vaginal hysterectomy offers the possibility to convert abdominal to vaginal approach give to the patient the benefits of ti. The analysis of the first 20 cases in our institution is done and are compared with abdominal and vaginal approaches in some parameters including costs, indications and hospitalization days. The laparoscopically assisted vaginal hysterectomy offers to the patient the benefits of the vaginal approach with hospital stay similar and cost and operative time higher than those for either vaginal and abdominal hysterectomy. The exact role of the laparoscopically assisted vaginal hysterectomy on daily practice still is pending.

Adult↗

PubMed2001

Laparoscopic treatment of hemorrhage after vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy (LAVH).

BACKGROUND: This study examines the use of laparoscopy for the treatment of secondary hemorrhage following vaginal or laparoscopically assisted vaginal hysterectomies (LAVH). METHODS: Over a 5-year period, the incidence and management of postoperative bleeding following vaginal hysterectomies or LAVH were registered prospectively. RESULTS: The overall incidence of hemorrhage after vaginal hysterectomies or LAVH was 1.2% (17 of 1319). Over the 5-year period, it decreased from 2.4% (five of 209) to 0.6% (two of 315). Surgical revision was initiated transvaginally in nine patients and by laparoscopy in eight patients. Five of the eight patients profited from the prompt use of laparoscopy; inconclusive vaginal exploration was followed by laparoscopy in another five patients. CONCLUSION: Hemorrhage following vaginal hysterectomy or LAVH can be treated by laparoscopy in the majority of patients. Laparoscopy is recommended if the source of bleeding cannot be identified clearly by vaginal examination and/or if an intraabdominal bleeding source is suspected.

Adult↗

PubMed2000

Total hysterectomy for benign pathologies: direct costs comparison between laparoscopic and abdominal hysterectomy.

OBJECTIVES: The aim of this study is a direct costs comparison between laparoscopic and abdominal total hysterectomy when theses procedures are indicated for benign pathologies. STUDY DESIGN: To this end we compared the direct costs of total laparoscopic hysterectomy (TLH) calculated from a series of 105 patients with that obtained for a comparable series of 30 patients who underwent hysterectomy by laparotomy. RESULTS: The direct costs of total hysterectomy for a benign pathology by laparoscopic surgery and laparotomy are comparable (respectively 7693 French francs (FF) and 7759 FF). Whatever the type of operation the cost for staff represents 60% of the total cost. Expenditure for staff during the operation represents 41.0% of the total cost of TLH (3154 FF/7693 FF) whereas it represents only 31.0% of the cost of the operation when carried out by laparotomy (2406 FF/7759 FF) (P<0.0001). Inversely the expenditure due to staff during the post operative phase represents 24.1% of the total cost of the operation when laparotomy is used (1875 FF/7759 FF) and only 13.4% of the cost of the operation by laparoscopic surgery (1029 FF/7693 FF) (P<0.0001). When the operation uses laparoscopic surgery the increase in expenditure during the surgical act is compensated by the statistically significant shortening in the hospital stay. Expenditure connected with the laparoscopic surgery equipment is minimal compared to the costs connected with the staff. CONCLUSION: Provided that TLH is carried out with reusable laparoscopic surgery equipment, by skilled surgeons working in suitable hospital structures making the particularly heavy investment in laparoscopic surgery equipment economically viable, TLH is an economically viable technique as an alternative to laparotomy.

Adult↗

PubMed1996

Early outcomes of laparoscopic-assisted vaginal hysterectomy versus laparoscopic supracervical hysterectomy.

STUDY OBJECTIVE: To compare two different laparoscopic techniques for hysterectomy: laparoscopic-assisted vaginal hysterectomy (LAVH) and laparoscopic supracervical hysterectomy (LSH). DESIGN: A retrospective review of office and hospital charts, and a postoperative questionnaire completed by patients. SETTING: A private gynecology practice and private hospital in Nashville, Tennessee. PATIENTS: Forty women requiring laparoscopic hysterectomy between January 1993 and December 1994. Interventions. Twenty patients underwent LAVH and 20 LSH. Minimum follow-up was 3 months (range 3-27 mo). MEASUREMENTS AND MAIN RESULTS: The chart review focused on operating times, blood loss, length of hospital stay, complications, and total hospital costs to the patients. The operating times were shorter and the blood loss was less in the LSH group than in the LAVH group, but the difference did not reach statistical significance. Hospital stay was shorter (p = 0.0005) and hospital costs were less (p = 0.01) in the LSH group. Of women who were sexually active, those in the LSH group resumed intercourse earlier than those in the LAVH group (3.5 vs 5.9 wks), and reported better overall improvement in sexual function and ability to achieve orgasm. CONCLUSION: In certain patients, LSH is effective and associated with few complications.

Adult↗

PubMed1993

Can laparoscopic assisted hysterectomy safely replace abdominal hysterectomy?

OBJECTIVE: To evaluate the feasibility, safety and advantages of laparoscopic hysterectomy. DESIGN: Retrospective review. SETTING: St. John of God Hospital, Perth, Australia. SUBJECTS: Fifty-four women scheduled to undergo laparoscopic hysterectomy for a variety of benign gynaecological conditions. MAIN OUTCOME MEASURES: Failure to complete the operation laparoscopically, time taken in theatre, incidence of febrile morbidity, incidence of major complications, duration of post-operative stay in hospital, interval from operation to full activity and return to work. RESULTS: Laparoscopic hysterectomy was attempted in 54 women. A total of 53 operations were completed laparoscopically with one conversion to laparotomy because of haemorrhage. Major complications occurred in two women, both of whom required further surgery. There were four cases of febrile morbidity. The average duration of post-operative stay was four days (range 2-9), with return to normal activity in two and a half weeks and to work in three weeks. CONCLUSIONS: Laparoscopic hysterectomy can be successfully achieved in most women selected for the procedure. Serious complications are inherent to some of the techniques used, but these can be overcome by modifications. Proper training and supervision in laparoscopic surgery is essential during the learning phase of the technique. There are considerable advantages to eligible women in terms of a rapid return to normal activities and work.

Adult↗

PubMed2004

A national survey of senior trainees surgical experience in hysterectomy and attitudes to the place of vaginal hysterectomy.

We set out to determine the current status of training in vaginal hysterectomy in the UK. In total, 255 year 4 or 5 'Calman' trainees were identified and sent an anonymous questionnaire assessing surgical experience, quality of training and attitudes towards vaginal hysterectomy. Our results demonstrate that senior trainees' experience in vaginal as opposed to abdominal hysterectomy is relatively poor. Despite this, trainees believed that the majority of hysterectomies should be done vaginally, and only a minority, laparoscopically.

Attitude of Health Personnel↗

PubMed2004

Tissue trauma after vaginal hysterectomy and colporrhaphy versus abdominal hysterectomy: a randomised controlled study.

OBJECTIVE: As the magnitude of tissue trauma can be detected by measuring the blood levels of acute phase reactants, we aimed to evaluate tissue trauma markers after abdominal hysterectomy (AH) and vaginal hysterectomy (VH). We hypothesised that VH will be associated with a reduced increase in the level of acute phase reactants than AH. METHODS: Thirty women out of 92 patients scheduled for hysterectomies between June 2002 and June 2003 were randomised into two equal groups (n = 15) of VH and AH. Their levels of C-reactive protein (CRP), alpha1-antitrypsin (alpha1-AT) and myoglobin (M) were analysed preoperatively and on the second, fourth and sixth days. RESULTS: In both methods of hysterectomy, the operating time (85.3 +/- 6.57 min in the VH group vs 69 +/- 7.54 min in the AH group, P < 0.0001), and hospital stay duration (7.2 +/- 2.5 days in the AH group, 3.1 +/- 1.1 days in the VH group, P < 0.0001) were highly significantly different from each other. Demographic parameters and other parameters which may affect tissue trauma markers were not statistically significantly different in each group. Postoperative increases in all markers were markedly high and showed a high statistical difference in both groups (P < 0.05). The postoperative CRP and M values in both groups were significantly higher in the AH group on the second and fourth days and on the sixth day for M only, whereas alpha1-AT levels were only statistically different on the second day. The tissue trauma markers returned to normal levels on the sixth postoperative day for M, although there still was a statistically significant difference, but remained higher than normal for alpha1-AT and CRP. CONCLUSION: Whenever possible, VH should replace AH because this technique leads to a shorter hospital stay and less tissue trauma, enabling patients to return to their normal lives.

C-Reactive Protein↗

PubMedDate not supplied

Laparoscopically assisted radical vaginal hysterectomy (Coelio-Schauta): A comparison with open Wertheim/Meigs hysterectomy.

The objective of this study was to compare the safety, efficacy, and short-term benefits of the Coelio-Schauta procedure with open Wertheim/Meigs radical abdominal hysterectomy. We retrospectively analyzed records of our first 35 consecutive patients undergoing laparoscopically assisted radical vaginal hysterectomy (LARVH) for early cervical cancer and 32 consecutive patients of open radical hysterectomy (ORH) performed between 1999 and 2005 in our institution. We analyzed patient age, bodyweight, previous abdominal surgery, operating time, blood loss, perioperative complications, postoperative bladder dysfunction, other postoperative complications, and histologic type. The FIGO stage, excision margins, node count and node status, follow-up, and recurrence rates were also taken into account. We excluded stage IA and stage II disease patients to reduce the impact of tumor size on the outcome of the surgery. This left 27 patients with stage IIB disease who had LARVH and 28 patients with stage IB disease who had ORH. These patients formed the study group. The cohorts were similar in age, bodyweight, previous abdominal surgery, histologic subtype, FIGO stage, resection margins, node count and node status, length of follow-up, and recurrence. There were statistically significant differences between LARVH and ORH for duration of surgery (mean 160 vs 132 min), intraoperative blood loss (479 vs 715 mL), hospital stay (mean 5 vs 9.3 days), postoperative complications (6 vs 20 patients), and duration of bladder catheterization (mean 4.4 vs 8.8 days). Four LARVH patients and no ORH patients had urinary tract injury that was repaired. None had long-term sequelae. Our data confirm that LARVH is a suitable alternative to ORH hysterectomy for small-volume stage IB1 cervical cancer with similar clinical efficacy and a superior postoperative recovery and postoperative morbidity profile. Urinary tract trauma is a clear risk in the early stages of the learning curve.

Adult↗

PubMed2000

Laparoscopically assisted vaginal hysterectomy. A suitable substitute for abdominal hysterectomy?

OBJECTIVE: To compare short-term clinical results in a retrospective case-control review of laparoscopically assisted vaginal hysterectomy (LAVH) versus total abdominal hysterectomy (TAH). STUDY DESIGN: One hundred seventeen women undergoing laparoscopically assisted vaginal hysterectomy were compared to 117 women undergoing total abdominal hysterectomy, with or without bilateral salpingo-oophorectomy. The perioperative and postoperative courses of the matched groups were compared. RESULTS: The time intraoperatively was longer in the LAVH group. The mean blood loss was increased in the LAVH group. The need for blood transfusion was higher in the LAVH group. The number of women with intraoperative complications differed significantly between LAVH and TAH. The number of postoperative complications did not. Postoperative time in the hospital was shorter in the LAVH group. The cost of the average case, including operating room time, instruments and hospital stay, did not differ. CONCLUSION: LAVH offers benefits to patients in the form of less time in the hospital and presumably, therefore, faster recovery, though at the expense of potentially longer intraoperative time, increased risk of blood transfusion and increased risk of intraoperative complications.

Abdomen↗

PubMed2001

[Differences in the psychological status of hysterectomy and non-hysterectomy women].

PURPOSE OF THE STUDY: Despite numerous investigations on the well-being of hysterectomized women, this issue is still discussed controversially. The aim of the present study was to reveal differences between a group of hysterectomized women with a fairly long follow-up period (7.9 years) and a group of non-hysterectomized women with respect to their psychological well-being. RESEARCH METHOD AND MATERIAL: In a questionnaire study we compared a group of 216 women who underwent hysterectomy with a group of 90 non-hysterectomized women. Dependent variables were: body complaints, psychological well-being, dysphoria, socio-sexual assertiveness, and gender-role orientation. RESULTS AND CONCLUSIONS: The group of hysterectomized women showed significantly higher levels of body complaints, depression, and unassertiveness in sexual situations, as well as decreased psychological well-being, and a more traditional gender-role orientation. Within the group of hysterectomized women, duration since hysterectomy, surgical techniques, and hormone substitution therapy seem to be unrelated to the psychological variables. The group differences cannot be causally attributed to the hysterectomy, since they may already have existed premorbidly. Nevertheless, the results suggest that a more thorough psychological examination prior to hysterectomy, as well as provision of support for the coping process after intervention is advantageous.

Adaptation, Psychological↗

PubMed1985

Peripartum hysterectomy: a review of cesarean and postpartum hysterectomy.

A retrospective review of 117 women who underwent peripartum hysterectomy at Duke University Medical Center during the past 21 years was conducted. Seventy-three cesarean hysterectomies were performed electively; 44 cesarean or postpartum hysterectomies were performed as emergencies. Statistically significant differences were noted between these groups in surgical technique, operative time, estimated blood loss, intraoperative hypotension, and intraoperative and total blood replacement. Additional significant differences were noted in postoperative febrile morbidity, use of therapeutic antibiotics, incidence of thromboembolic phenomena, and length of postoperative hospital stay. Separate analysis of elective cesarean hysterectomy patients revealed statistically significant decreases in operative time, estimated blood loss, intraoperative and total blood replacement, and postoperative hospital stay in the group having an experienced surgeon when compared with the group with less experienced surgeons.

Adolescent↗

PubMed1984

[Extended indication for hysterectomy. Changes in the incidence and indications in hysterectomy within 2 decades].

At the Gynaecological Department of the Medical Hospital of the University of Hannover, the medical reports of two periods (1960 to 1963 and 1978 to 1980) were employed to investigate hysterectomies and a number of uterus-preserving procedures, the indications for which could also have served as an indication for hysterectomy. As compared with the first period, the average hysterectomy rate per age group was almost twice as high in the second period, while uterus-preserving surgery was virtually insignificant in the later period. In the second period, patients were younger and had less severe complaints. In the second period, sterilization and carcinoma prophylaxis represented major secondary indications for the operation. Overall, the result point to a considerable expansion of indications in the second period. However, owing to the fact that the operation carries a risk that cannot be neglected, sterilization of carcinoma prophylaxis alone cannot be considered a sufficient reason for hysterectomy.

Female↗

PubMedDate not supplied

Total hysterectomy versus subtotal hysterectomy: which procedure should be performed during the pregnant-puerperal period?

A retrospective study of 40 hysterectomies due to hemorrhage performed at the "Hospital das Clínicas, Faculdade de Medicina de São Paulo", from January 1978 to August 1989 was conducted in order to determine which type of hysterectomy (total or subtotal) is better indicated during the pregnant-puerperal period. We analyzed operating time, quantity of blood derivatives transfused during the intra- and postoperative periods, time of postoperative hospitalization, number of intra- and postoperative complications, and deaths. The results did not show statistically significant differences between the two types of hysterectomy. We conclude that total hysterectomy is preferable in any clinical situation, especially in the presence of uterine atony and low implanted placenta.

Female↗

PubMed1996

[Endometrial cancer: total simple hysterectomy or radical hysterectomy? Abdominal or vaginal route?].

Total abdominal hysterectomy and bilateral salpingo-oophorectomy has long been the standard surgical treatment for endometrial cancer. Radical hysterectomy is not useful in stage I. in women with extreme obesity and medical risk factors, vaginal hysterectomy is recommended. Laparoscopy-assisted vaginal hysterectomy complete the oncologic treatment if lymphadenectomy is necessary.

Endometrial Neoplasms↗

PubMed2026

Vaginal Hysterectomy Versus Vaginal Assisted Natural Orifice Transluminal Endoscopic Surgery Hysterectomy; Results of a Randomised Controlled Trial.

OBJECTIVE: To compare Vaginal Hysterectomy (VH) with Vaginal Assisted Natural Orifice Transluminal Endoscopic Surgery (NOTES) hysterectomy (VANH) as a day-care procedure. DESIGN: Single-blind, multicentre randomised controlled trial. SETTING: Two Dutch non-academic teaching hospitals. POPULATION: Women aged ≥ 18 years undergoing hysterectomy for benign indications. METHODS: Women were randomised 1:2 (VH or VANH). Primary outcome was SDD. Secondary outcomes included operative time, rate of elective salpingectomies, intraoperative blood loss, complications (Clavien-Dindo), pain scores (NRS) and analgesic use, post-operative recovery (RI-10), and quality of life (EQ-5D-5L). Analyses were performed on an intention-to-treat basis. RESULTS: A total of 113 patients were included in the analyses (n = 42 VH, and n = 71 VANH). SDD occurred significantly more frequently in the VANH group (87.3%) than VH group (71.4%; OR 2.76, 95% CI 1.04-7.25; p = 0.04). VANH was associated with a significantly shorter operative time (median 55 min versus 65 min; p = 0.005), less blood loss (median 50 mL vs. 150 mL; p < 0.001) and more often elective opportunistic salpingectomy compared to VH (100% vs. 77.4%; p = 0.008). NRS were significantly lower in the VANH group the first hour post-operative (3 vs. 1, p < 0.001). Post-operative complications (VH 9.5% vs. VANH 15.5%; p = 0.34), readmission (VH 4.8% vs. VANH 8.5%; p = 0.47), analgesic use, recovery, and quality of life were not statistically significant. CONCLUSIONS: VANH is a safe and effective alternative to VH, offering a higher likelihood of SDD, shorter operative time, reduced blood loss, and more often an elective salpingectomy, without increased complications or differences in pain, recovery, or quality of life.

Humans↗

PubMed1994

Laparoscopic-Assisted Vaginal Hysterectomy: A Case Control Comparative Study with Abdominal Hysterectomy

A case control study of the operative time, blood loss, time for return to work, pain levels, and medications was conducted comparing laparoscopic-assisted vaginal hysterectomies (LAVH) with total abdominal hysterectomy (TAH). The average operating time for LAVH was 151 minutes whereas for TAH it was 99 minutes (P<.01). The average length of stay for the LAVH was 2.5 days and for the abdominal hysterectomy it was 3.5 days (P<.01). During hospitalization the LAVH group required an average of 180 mg of meperidine while the TAH group required 414 mg of meperidine (P<.01). Patients undergoing LAVH reported activity levels of 9.2 on a scale of 1 to 10, with 10 being unlimited activity, by day 14. Abdominal hysterectomy patients' activity was reported as only 6.4 on the same scale (P<.005). The LAVH group, although requiring more operating time, made a more rapid recovery, and less pain medication, and required shorter hospitalization than the TAH group.

Journal Article↗