Abstract
Objective: Total vaginal hysterectomy (TVH) and total abdominal hysterectomy (TAH) are presently the standard procedures for total hysterectomy. Since the advent of laparoscopically assisted vaginal hysterectomy (LAVH), our institution has actively performed LAVH to establish it as standardized procedure for patients with uterine myomas and those with uterine adenomyosis. This report investigates the parameters to determine LAVH to be considered a standardized procedure.
Method: In our institution, 282 LAVH cases were performed from 1995 to 2001 (Group I), 258 cases from 2002 to 2010 (Group IIa) by "experts", and 83 cases by non-expert Ob/Gyn surgeon (Group IIb). The groups were compared by age and parity of the patients; uterine weight; operative time; blood loss; rates of intraoperative conversion to open surgery; and intra- and post-operative complications. The trend in the annual rate of LAVH was also examined.
Results: There were no significant differences in age, parity, blood loss, or conversion to open surgery. Uterine weight was significantly lower (350g) and operative time significantly longer (163min) in Group IIb than in Groups I (400g/143min) and IIa (411g/143min). The annual LAVH rate has increased continually, from 16.2% in 1995 to 85.7% in 2010.
Discussion: Because no difference was observed in blood loss or complication rates among the three groups of patients, the authors have concluded that LAVH can be performed by all gynecological surgeons. Presently, LAVH is performed for the majority of patients requiring total hysterectomy. Therefore, LAVH has been established as the institution's standardized procedure for total hysterectomy.
