Comparison of Laparoscopically Assisted Vaginal Hysterectomy and Abdominal Hysterectomy: A Randomized Controlled Trial.

Author(s): Kongwattanakul K, Khampitak K

Affiliation(s): Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Publication date & source: 2011-11-29, J Minim Invasive Gynecol., [Epub ahead of print]

OBJECTIVE: To compare intraoperative hemorrhage and other operative parameters after laparoscopically assisted vaginal hysterectomy (LAVH) versus total abdominal hysterectomy (TAH) for benign gynecologic conditions. DESIGN: A prospective, randomized, controlled trial. MATERIALS AND METHODS: Between April 2010 and March 2011, 50 Thai patients with strong indications for hysterectomy-with uterine sizes </=16 weeks of gravid uterus and with no contraindications for open or laparoscopic surgeries-were randomly assigned for LAVH or TAH. MAIN OUTCOME MEASURES: Intraoperative blood loss, operating time, postoperative analgesic requirements, perioperative complications, and duration of hospitalization. RESULTS: Intraoperative blood loss was significantly less in the LAVH group (median 120 mL [range 50-300]) than in the TAH group (median 250 mL [105-800]) (median difference 130 mL, p <.001, 95% confidence interval [CI] 55-200). The LAVH group required significantly less postoperative morphine sulfate administration (median 3 mg [range 0-12]) than the TAH group (15 mg [6-24]) (median difference 9 mg, p <.001, 95% CI 9-12). The hospital stay for the LAVH group (median 3 days; range 2-7) was significantly shorter than that of the TAH group (median 4 days; range 4-5) (median difference 2 days, p <.001, 95% CI 1-2). The operating time was comparable between the 2 groups (median 100 minutes; range 50-240) for the LAVH and 115 minutes (range 60-200) for the TAH group (median difference 5 minutes, p =.592, 95% CI -15-25). There were no conversions from a LAVH to a laparotomy. CONCLUSIONS: The LAVH has advantages over the TAH in that in the former there is less intraoperative blood loss, less postoperative morphine requirement, and a shorter duration of postoperative hospital stays. Copyright (c) 2011 AAGL. Published by Elsevier Inc. All rights reserved.