Laparoscopically assisted vaginal hysterectomy at a health maintenance organization. Cost-effectiveness and comparison with total abdominal hysterectomy.

Fifty laparoscopically assisted vaginal hysterectomies (LAVHs) were compared with 46 total abdominal hysterectomies (TAHs) at a health maintenance organization for operating time, preoperative and postoperative hematocrit, estimated blood loss, major and minor complications, length of hospital stay and disability until return to normal work duties. Indications for surgery, parity and weight were similar for both groups. Although operating time and blood loss were greater for LAVH, hospital stay was statistically significantly shorter, disability time was shorter, and return to normal activity was sooner. The cost of nonreusable instruments was $1,250 per case, far lower than in other settings. The potential for a shorter recovery time and real cost savings would be considerable if LAVH could convert an abdominal to a vaginal approach.