Laparovaginal hysterectomy: A decade of evolution

Objective: To compare surgical outcomes for laparoscopically-assisted vaginal hysterectomy (LAVH) to total laparoscopic hysterectomy (TLH) and to document the modifications to the technique of laparovaginal hysterectomy which have occurred over the last decade at Flinders Endogynaecology, South Australia, Australia. The method of choice at the start of the decade was LAVH and by the end of the study period it had been superceded by TLH. Sample: Seven hundred and ninety-four consecutive women underwent hysterectomy between January 1992 and December 2001 at Flinders Endogynaecology. This included 424 women who underwent TLH and 370 who underwent LAVH. Methods: Retrospective review of case history notes and manual extraction of data. Main outcome measures: Demographic data including patient age, weight and parity were extracted. Intraoperative complications including ureteric injury, cystotomy, bowel damage or conversion to open procedure were recorded. The rate of non-autologous blood transfusion was recorded and miscellaneous data including length of procedure, estimated blood loss, length of hospitalisation, concomitant procedures carried out and re-admission rates were also recorded. Results: There was a statistically significant reduction in major morbidity in the TLH group when compared to the LAVH group. The lower rate of conversion to laparotomy in the TLH group was statistically significant (3.0 vs 0.9%). A non-significantly higher rate of ureteric injury was observed in the TLH group (0.7 vs 0.3%). Other outcome measures showed a trend toward an improved outcome for TLH but were not statistically significant. This includes a lower rate of bowel injury in the TLH group (0 vs 0.3%), a lower rate of cystotomy in the TLH group (1.4 vs 3.0%) and lower rate in non-autologous blood transfusion in the TLH group (1.2 vs 3.0%). There was a statistically significant reduction in hospital stay from 4.5 days in the LAVH group to 3.4 days in the TLH group. Conclusion: The evolution of laparovaginal hysterectomy from LAVH to TLH over the last 13 years has resulted in improved patient outcomes. Ongoing modification of the technique to ensure ureteric protection must remain a priority.