Clinical experiences with laparoscopically assisted vaginal hysterectomy in patients who are candidates for abdominal hysterectomy

Objective To report our 3-year experience with laparoscopically assisted vaginal hysterectomy (LAVH) in patients who were candidates for abdominal hysterectomy. Design Between 1997 and 2000, 50 LAVH procedures were done by the authors. All the patients underwent LAVH because of the contraindications to the vaginal route. A 10-mm infraumbilical trocar, and two 5-mm trocars, one for each lower quadrant, were placed in all patients. An initial careful inspection of both ureters was carried out but no dissection of ureters was performed, in order to reduce operative time and minimize the risk of bleeding or ureteral vascular compromise. After the dissection of the broad, round and infundibulopelvic ligaments, the bladder was displaced inferiorly with blunt and sharp dissections. The remainder of the surgery was done vaginally, following the entrance to anterior and posterior vaginal fornices. Results The average operating time was 87 min with a range of 64-96 min. LAVH was not converted to an abdominal procedure in any patient. There were no intraoperative or postoperative complications. The mean uterine weight was 260 +/- 45 g and the mean blood loss was 350 mL. The patients remained in the hospital for a mean of 2.5 +/- 1 days. Conclusions We believe that LAVH is not a substitute for vaginal hysterectomy; however LAVH should be a surgical option at all centres, to be used when the indications are appropriate, especially when vaginal hysterectomy is not possible.