Role of laparoscopic assisted vaginal hysterectomy in gynecology.

One hundred and thirty laparoscopic assisted vaginal hysterectomies (LAVH) were performed at Chang Gung Memorial Hospital. All hysterectomies were for indications of the uterus, endometriosis, and extensive adhesions. Some of the patients also underwent concomitant procedures including unilateral or bilateral salping-oophorectomy, vaporization and/or excision of endometriosis, lysis and/or excision of adhesions. Kleppinger bipolar forceps were used for large vessel hemostasis and excision of adhesions in all the patients. CO2 laser was used for vaporization and excision of endometriosis. The complication rate was 10.0%. This included febric morbidity, intraoperative bladder injury, partial small bowel obstructions and thermal injury of the sigmoid colon. Four patients required laparotomy either to complete the procedure or to manage the complications. The mean blood loss was 160 ml and the mean hospital stay was 2.2 days. The mean operating time was 148 minutes and the mean age of the patients was 42.3 years. Two weeks after surgery, the majority of the patients were permitted to drive and resume normal nonstrenuous physical activity. The majority of the surgeries were videotaped. The study demonstrates that a hysterectomy can be safely performed laparoscopically by the well trained laparoscopic surgeon, resulted in reduced surgical morbidity, blood loss, postoperative discomfort and pain, shortened hospital stay and recovery.