Laparoscopically assisted vaginal hysterectomy (LAVH)--an alternative to total abdominal hysterectomy.

OBJECTIVE

To assess the feasibility of performing laparoscopically assisted vaginal hysterectomy (LAVH) on women referred for total abdominal hysterectomy (TAH).

DESIGN

Prospective intervention study on women referred for TAH from a gynaecological outpatient clinic.

SETTING

Groote Schuur Hospital, Cape Town. This institution accepts patient referrals from community hospitals and family physicians for hospitalised care.

PATIENTS

Forty-one consecutive women referred for TAH were suitable for LAVH. Women able to undergo conventional vaginal hysterectomy, women with uterine fibroids exceeding 14 weeks in size and subjects with malignant disease were excluded. The most common indication for hysterectomy was persistent abnormal bleeding.

INTERVENTION

Of the 41 women assessed pre-operatively as suitable for LAVH, the procedure was successfully performed in 40 by means of a bipolar desiccation and scissors transection technique with re-usable equipment.

MAIN OUTCOME MEASURES

Assessment of intra-operative and postoperative morbidity, surgical complications, operating time, length of hospitalisation and assessment at postoperative visit 6 weeks after surgery.

RESULTS

Only 1 woman was unable to undergo successful LAVH because she had pelvic adhesions and densely adherent loops of bowel; a TAH was performed. No operative complication occurred. One woman had postoperative vaginal bleeding controlled with a vaginal pack, and a diagnosis of von Willebrand's disease was subsequently established. No patient had febrile morbidity and when reviewed at clinic 6 weeks later all women were well.

CONCLUSIONS

LAVH is possible in many women in whom hysterectomy is indicated but conventional vaginal hysterectomy is not feasible. In this study LAVH was found to be a safe procedure with minimal complications.