European Journal of Obstetrics & Gynecology and Reproductive Biology
A prospective randomized comparison of vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy, and total laparoscopic hysterectomy in women with benign uterine disease
Introduction
Hysterectomy is one of the most common gynecological operations worldwide [1]. In the United States, approximately 600,000 hysterectomies are performed annually, the majority of which are performed for benign conditions [1], [2], [3], [4]. Efforts to decrease intra-operative, as well as post-operative, morbidity have focused on decreasing the total number of hysterectomies performed and on developing additional techniques as alternatives to abdominal hysterectomy. Currently, there are several methods of hysterectomy including abdominal hysterectomy (AH), supracervical hysterectomy, and minimally invasive techniques such as vaginal hysterectomy (VH), laparoscopically assisted vaginal hysterectomy (LAVH), total laparoscopic hysterectomy (TLH), and more recently, robotic hysterectomy.
Several studies have compared the less invasive techniques to abdominal hysterectomy [4], [5], [6], [7], [8], [9], [10], [11], [12], many of these were retrospective reports [5], [9], [10]. However, few studies have compared minimally invasive techniques individually, making it difficult to successfully determine which procedure would be most advantageous for a patient. Therefore, the aim of this study was to compare intra- and post-operative morbidity associated with three minimally invasive hysterectomy procedures (VH, LAVH, and TLH) in patients with similar characteristics and indications.
Section snippets
Materials and methods
This was a prospective, randomized study performed at a tertiary care center between March 2004 and October 2005. A total of 125 women scheduled to undergo a hysterectomy for benign disease were enrolled in the study and randomly assigned to three groups: vaginal hysterectomy (VH, n = 40), laparoscopically assisted hysterectomy (LAVH, n = 44), and total laparoscopic hysterectomy (TLH, n = 41). Randomization was performed using computer-generated random numbers to divide patients evenly among the
Results
A comparison of the preoperative patient characteristics is presented in Table 1. The observed differences in age, BMI, parity, or the percentage of patients with a prior uncomplicated intra-abdominal surgery between the groups were not statistically significant. There were five main indications for hysterectomy in our study population, with uterine myomas and abnormal uterine bleeding being the most common (Table 2).
Table 3 compares the outcome measures evaluated during and after surgery.
Discussion
It is difficult to determine which approach to hysterectomy is most beneficial. Therefore, the three minimally invasive methods were evaluated.
In our study, the VH group experienced the shortest operation time and the TLH group, the longest. This is in agreement with other studies that have reported a shorter operating time for VH compared to LAVH [12], [13], [14], [15] and for LAVH compared to TLH [16]. Mean blood loss was highest in the LAVH group. One patient in the LAVH group suffered
Acknowledgement
This study was supported by the Internal Grant Agency of the Ministry of Health of the Czech Republic, grant no. XG/7915-2.
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