Laparoscopically assisted vaginal hysterectomy in a university hospital. Decreasing the need for abdominal hysterectomy and increasing resident experience in vaginal surgery.

OBJECTIVE

To demonstrate, in a university hospital setting, that the introduction of laparoscopically assisted vaginal hysterectomy reduced the need for abdominal hysterectomy and increased resident experience in vaginal surgery.

STUDY DESIGN

All hysterectomies performed for benign gynecologic disease during one year, 1993-1994, at the Medical University of South Carolina Hospital, Charleston, after introduction of laparoscopically assisted vaginal hysterectomy were compared to those performed in preceding years, 1990-1993.

RESULTS

Prior to 1993, > 70% of hysterectomies at the Medical University of South Carolina Hospital were performed abdominally. With the introduction of laparoscopically assisted vaginal hysterectomy, from a total of 155 hysterectomies performed in 1993-1994, the percentage of hysterectomies performed abdominally decreased to 39 without affecting the overall percentage of traditional vaginal hysterectomies, 29. Since laparoscopic hysterectomies were completed with a significant vaginal component to the operation, the actual resident experience with vaginal hysterectomy increased to 61% of hysterectomies. Straightforward vaginal hysterectomies were performed on patients with higher parity and traditional indications, such as cervical intraepithelial neoplasia and prolapse. Patients who underwent laparoscopically assisted vaginal hysterectomy were not considered candidates for traditional vaginal hysterectomy and had significantly fewer complications and hospital days but did have significantly smaller uteri and greater hospital charges than did patients who underwent abdominal hysterectomy (P < .05). No significant difference was found for length of operating time or blood loss between each method of hysterectomy.

CONCLUSION

Laparoscopically assisted vaginal hysterectomy, when used as an alternative to abdominal hysterectomy in patients not considered candidates for vaginal hysterectomy, decreased the need for abdominal hysterectomy, with fewer complications, and shorter hospital stay and increased resident experience with vaginal surgery.