ABSTRACT
Introduction: Hysterectomy is second mostfrequent gynecological operation. Historicallythe uterus has been removed by either theabdominal or vaginal route. The vaginaloperation is preferable when there are nocontraindications because of lower morbidityand quicker recovery. Since it was first reportedby Reich et al in 1989 laparoscopically assistedvaginal hysterectomy (LAVH) has gainedwidespread acceptance. To compare totallaparoscopic hysterectomy (TLH), laparoscopicassistedvaginal hysterectomy(LAVH), vaginalhysterectomy (VH) and total abdominalhysterectomy(TAH).Materials and methods: A prospective,randomized study was performed atGynecologic Surgery Department of NationalCancer Center of Mongolia between March2013 and January 2014. A total of 120 womenindicated to undergo hysterectomy for cervixcancer stage 0-1, uterine myoma, uterinecancer were randomly assigned to fourdifferent groups (30 VH, 30 LAVH,30 TLH and30 TAH). Operating time, blood loss, rate ofcomplications, consumption of analgesics andlength of hospital stay were measured in eachgroup.Results: In our research the groups weresignificantly different for mean intraoperativeblood loss were TLH:119+/-54.7mL, LAVH:127.5+/-52.7 mL, VH; 145+/-57.8 mL andTAH: 210+/-77.4mL (P=.007) and operativetime were TLH 115+/-16.6 minutes LAVH:112.5 +/-18.5 minutes; VH: 51.6 +/-16.9minutes;TAH:69+/-18.2 (P = .001). Theaverage weight of uterine were from 95.1+/-27.6mg (range 58-140) in the VH group ,to 181.2+/-97 (range 76-400g) in the LAVHgroup through to 122.3+/-64 for the TAHgroup. Postoperative pain on day 0 and thetotal abdominal group were 5.5+/-0.7 days ofanalgesic request it was higher than other threegroups (TLH: 3.0+/-0.8days, LAVH: 3.08+/-0.7days, VH: 3.0+/-0.86 days P<.001). LAVHwas associated with a reduced hospital stay(TLH: 3.3+/- 0.7, LAVH: 3.3 +/- 0.6 days;VH: 3.7 +/- 0.6 days;TAH:6.5+/-0.7 P <.001). Total Laparoscopic hysterectomy hadlongest operating time (115+/- 16.6min), a lowcomplication rate, lack of severe post-operativecomplications. Vaginal hysterectomy had theshortest operating time (51.6+/-16.9min).However, there were technical problems withsalpingo-oophorectomy from the vaginalapproach and this group had a significantlyhigher rate of febrile complications (20%)compared to LAVH (2.3%) and TAH (16%).Conclusion: Even though operative timefor VH is less than TLH, there is a technical problem known as salpingo-oophorectomy.TLH and LAVH have number of advantagesincluding less interaoperative blood lose, lesspostoperative analgesic requirement, andshorter duration of postoperative hospitalstays.
ABSTRACT
BACKGROUND: Hysterectomy is second most frequent gynecological operation. Historically the uterushas been removed by either the abdominal or vaginal route. The vaginal operation is preferablewhen there are no contraindications because of lower morbidity and quicker recovery. Since it wasfirst reported by Reich et al in 1989 laparoscopically assisted vaginal hysterectomy (LAVH) hasgained widespread acceptance.OBJECTIVES: To compare the outcome measures which including operating time, blood loss, rateof complications, consumption of analgesics, and length of hospital stay of total laparoscopichysterectomy (TLH), laparoscopic-assisted vaginal hysterectomy(LAVH), vaginal hysterectomy(VH) and total abdominal hysterectomy(TAH).METHODS: A prospective, randomized study was performed at Gynecologic Surgery Department ofNational Cancer Center of Mongolia between March 2013 and January 2014. A total of 110 womenindicated to undergo hysterectomy for cervix cancer stage 0-1, uterine myoma, and uterine cancerwere randomly assigned to four different groups (30 VH, 30 LAVH, 20 TLH and 30 TAH).RESULTS: In our research the groups were significantly different for mean intraoperative blood losswere TLH: 119+/-54.7mL, LAVH: 127.5+/-52.7 mL, VH; 145+/-57.8 mL and TAH: 210+/-77.4mL(P=.007) and operative time were TLH 115+/-16.6 minutes LAVH: 112.5 +/-18.5 minutes; VH:51.6 +/-16.9 minutes; TAH: 69+/-18.2 (P = .001). The average weight of uterine were from 95.1+/-27.6mg (range 58-140) in the VH group, to 181.2+/-97 (range 76-400g) in the LAVH group throughto 122.3+/-64 for the TAH group. Postoperative pain on day 0 and the total abdominal group were5.5+/-0.7 days of analgesic request it was higher than other three groups (TLH: 3.0+/-0.8days,LAVH: 3.08+/-0.7days, VH: 3.0+/-0.86days P <.001). LAVH was associated with a reduced hospitalstay (TLH: 3.3+/- 0.7, LAVH: 3.3 +/- 0.6 days; VH: 3.7 +/- 0.6 days;TAH:6.5+/-0.7 P < .001). TotalLaparoscopic hysterectomy had longest operating time (115+/- 16.6min), a low complication rate,lack of severe post-operative complications. Vaginal hysterectomy had the shortest operatingtime (51.6+/-16.9min). However, there were technical problems with salpingo-oophorectomy fromthe vaginal approach and this group had a significantly higher rate of febrile complications (20%)compared to LAVH (2.3%) and TAH (16%).CONCLUSION: However TLH, LAVH and VH seem to be operative time, blood loss and hospitalstay, VH were technical problem salpingo-oopheretomy. TLH and the LAVH has advantages overthe TAH in that in the former there is less intraoperative blood loss, less postoperative analgesicrequirement, and a shorter duration of postoperative hospital stays.