Comparative clinical study of laparoscopic assisted vaginal hysterectomy and non-descent vaginal hysterectomy

Background: Laparoscopic assisted vaginal hysterectomy (LAVH) is increasingly becoming popular. It's really a technique made to replace abdominal hysterectomy. The need of the hour is the minimal invasive surgery, early discharge from the hospital, early resumption of work, avoidance of disfiguring scar on the abdomen and cost-effectiveness of the procedure which are as important as cure of the disease. The objective of this study is to compare the effectiveness and safety of laparoscopic and vaginal hysterectomies for non-descent uteri (NDVH).Methods: The study was undertaken in the department of obstetrics and gynecology, Amrita Institute of Medical Sciences, Kochi for the period of one year. About 50 women in each group undergoing LAVH and NDVH for benign pelvic conditions were studied preoperatively, intra-operatively and post-operatively in detail for indications, operative time, intraoperative blood loss, duration of stay in hospital.Results: The mean operative time in LAVH was 240.6 minutes and in NDVH 168.3 minutes. Minimum duration of stay was in LAVH 3 days and in NDVH 4 days. Mean duration of stay in both groups was 6.4 days. Maximum duration of stay-15 days in both groups.Conclusions: LAVH is a better approach for a larger uterus whereas NDVH is preferable for a small uterus, not only for shorter operative time and minimal wound, but also for much lower costs.

Study of route of hysterectomy

Background: The objective is to study complication rate, advantages and outcome of different route of hysterectomy.Methods: A prospective study of 175 women over a period of 1 year i.e. from 01/01/2011 to 31/12/2011 SSG hospital, Vadodara. Depending on the patient profile, experience of surgeon optimum route of hysterectomy was decided.Results mean operating time in AH group was 68.4±14.4min, which was 80±10.3min, 115.8±40.6min and 148.8±25.5min in NDVH, LAVH and TLH group respectively. TLH was performed by consultants. Febrile morbidity was significantly high in AH (23%). Bladder and ureteral injuries were seen in 4% and 3% cases of NDVH and AH group. Wound complications were seen in AH (10%), whereas vault complications were higher in TLH. The hospital stay was shortest in TLH. Women with TLH had early ambulation, early resumption to normal diet, early return to routine work and better sexual function.Conclusions: Women with excessively enlarged uteri, significant pelvic pathology, or cancer are obvious candidates for AH. On the other hand, VH is frequently chosen for the small uterus in a multiparous woman with a large pelvis and no prior pelvic inflammatory disease or surgery. Although TLH, LAVH have significantly lower complication rate than AH, but overall cost is higher owing to the high operating room charges. The final selection of hysterectomy route should be based on surgeon’s experience and indication for surgery.

RESEARCH ABOUT LAPAROSCOPY ASSISTED VAGINAL HYSTERECTOMY / Шинэ санаа Шинэ нээлт

Hysterectomy is still the most common major operation performed by gynecologists. Having said that the incidence of hysterectomy has increased last 20 years with new minimally invasive technique. Laparoscopy assisted vaginal hysterectomy has advantage like small incision, less operative pain, quicker recovery, less hospital stay comparing to the abdominal open surgery. Objective: To compare the outcome of abdominal hysterectomy and laparoscopic vaginal hysterectomy.The study population comprised all patients who had LAVH and abdominal hysterectomy at First Maternity Hospital, from June 2013 to December 2014.The mean age of both group is same (46.2±5.3). Duration time of LAVH is approximately 2.30±-5.9minutes and of total abdominal hysterectomy is a 1.41±2.7 minute. The general blood loss during LAVH is 74.4±19 ml and during total abdominal hysterectomy is 185.2 ± 67 ml. After LAVH any patient had no complaints. After LAVH the patient stayed at the hospital for 3 days. LAVH took significantly longer operating time than TAH. Blood loss was jess during LAVH. Hospital stay after LAVH was less than TAH. Drug cost is more case LAVH.

Laparoscopic Assisted Vaginal Hysterectomy: A Case Control Comparative Study with Total Abdominal Hysterectomy.

This case control study was conducted in the department of Gynae & Obstetrics, Sir Salimullah Medical College & Mitford Hospital (SSMC & MH), Dhaka, during the period of January 2008 to December 2008 to compare the length of operation, blood loss, length of hospital stay, drug requirements for pain and post-operative pain and activity levels between Laparoscopically Assisted Vaginal Hysterectomy (LAVH) & Total Abdominal Hysterectomy (TAH). A total of 50 patients who met some eligibility criteria were consecutively included in the study and matched in a case control manner for age, weight, diagnosis & uterine size. The procedures were performed by the same surgeon. On average, LAVH operations took significantly longer than TAH operations (P<0.001). Equal number of patients of both groups (40%) needed blood transfusion. No significant difference about haemoglobin level compared to TAH group on 3rd POD (P=0.246). However total amount of analgesics needed was much higher in the TAH group than that of the LAVH group (243.7 ± 40.3VS 182.1 ± 69.6 mg; P= 0.005) and the total cost of operation was significantly less in the TAH group (4500 ± 500 takas) than in the LAVH group (6500 ± 500 taka) (P<0.001). It was observed that LAVH group produced earlier relief from pain in terms of pain VAS on 3rd POD, (P<0.001). LAVH is less painful, has a shorter length of hospital stay and quicker return to work than TAH. Moreover LAVH does not increase intra or postoperative complications.

Impact of duration of catheter following LAVH on voiding outcome / 中国实用护理杂志

Objective To explore the impact of duration of catheter on incidences of PUR,UTI and reinserting catheter following LAVH,in order to determine the best time for withdrawing catheter.Methods 139 patients in keeping with the selected criteria were randomly divided into the non-catheter group,indwelling one-day and two-day group.The incidences of PUR,UTI and reinserting catheter were analyzed.Results There was significant difference in PUR and UTI among the three groups,and no difference was seen in reinserting catheter among them.Conclusions The catheter should be withdrawn as early as possible to prevent UTI.

Effects of Preincisional Ketamine on Postoperative Pain after Laparoscopic Assisted Vaginal Hysterectomy

BACKGROUND: We evaluated the effect of preincisional injection of a small dose of ketamine on postoperative pain after laparoscopic assisted vaginal hysterectomy (LAVH). METHODS: Fourty patients undergoing LAVH were randomly allocated to one of two groups. Group K received ketamine 0.5 mg/kg IV. Group N received normal saline IV as a control group. Postoperative pain was rated at 1, 3, 6, 12, and 24 hr postoperatively by visual analog scale (VAS). The incidence of patients requiring analgesics in the PACU and on the ward, the time to the first analgesic request and side effects were recorded. RESULTS: At 1, 3, 6, 12, 24 hr after surgery, patients in the group K had significantly lower VAS than those in the group N (P < 0.05). The incidence of patients requiring analgesics in the postanesthetic care unit (PACU) and on the ward was not significantly different in the group K compared with group N. There were no significant differences in the first analgesic request time and the incidence of side effects in both group. CONCLUSIONS: Preincisional treatment with ketamine 0.5 mg/kg IV reduces postoperative pain after LAVH.

Comparison study on results of LAVH according to prior abdominal surgery / 대한산부인과학회지

OBJECTIVE: To evaluate the result of laparoscopically assisted vaginal hysterectomy (LAVH) according to history of prior abdominal surgery. METHODS: From January, 2003 to June, 2005, a total of 504 patients were performed LAVH at our Hospital. The patients were divided into 2 groups: Group of non prior abdominal surgery (Op. Hx(-) group) included 262 cases and group of prior abdominal surgery (Op. Hx(+) group) had 242 cases. We reviewed medical records and analyzed these cases regarding age, parity, weight, height, operation indication, operation outcome, duration of hospitalization and complication. RESULTS: There were no differences in terms of patients' mean age, parity, weight and height, and indications for surgery between the two groups. Mean operation time of Op. Hx(+) group (86.9+/-28.2 min) was longer than Op. Hx(-) group (80.7+/-20.0 min). There was no statistical difference on mean postoperative hemoglobin drop and mean uterine weight between the 2 groups. Mean hospital stay of Op. Hx(+) group (4.6+/-1.7 days) was longer than Op. Hx(-) group (4.3+/-0.9 days). The incidence of major surgical complications was higher in Op. Hx(+) group (10 cases - 4.1%) than Op. Hx(-) group (3 cases - 1.2%). In case of blader injury, Op. Hx(+) group (5 cases) was higher than Op. Hx(-) group (0 case). Op. Hx(+) group had 2 ureteral injuries and 1 rectal injury but there were no statistical differences. In case of trocar site bleeding, both group had 2 cases trocar site bleeding respectively. Op. Hx(-) group had 1 inferior vena cava injury but there was no statistical difference. CONCLUSION: At the time of LAVH, the incidence of bladder injury was higher in group of patients with history of prior abdominal surgery. So special attention should be paid to prevent bladder injury.

Comparison study on results of LAVH according to prior abdominal surgery / 대한산부인과학회지

OBJECTIVE: To evaluate the result of laparoscopically assisted vaginal hysterectomy (LAVH) according to history of prior abdominal surgery. METHODS: From January, 2003 to June, 2005, a total of 504 patients were performed LAVH at our Hospital. The patients were divided into 2 groups: Group of non prior abdominal surgery (Op. Hx(-) group) included 262 cases and group of prior abdominal surgery (Op. Hx(+) group) had 242 cases. We reviewed medical records and analyzed these cases regarding age, parity, weight, height, operation indication, operation outcome, duration of hospitalization and complication. RESULTS: There were no differences in terms of patients' mean age, parity, weight and height, and indications for surgery between the two groups. Mean operation time of Op. Hx(+) group (86.9+/-28.2 min) was longer than Op. Hx(-) group (80.7+/-20.0 min). There was no statistical difference on mean postoperative hemoglobin drop and mean uterine weight between the 2 groups. Mean hospital stay of Op. Hx(+) group (4.6+/-1.7 days) was longer than Op. Hx(-) group (4.3+/-0.9 days). The incidence of major surgical complications was higher in Op. Hx(+) group (10 cases - 4.1%) than Op. Hx(-) group (3 cases - 1.2%). In case of blader injury, Op. Hx(+) group (5 cases) was higher than Op. Hx(-) group (0 case). Op. Hx(+) group had 2 ureteral injuries and 1 rectal injury but there were no statistical differences. In case of trocar site bleeding, both group had 2 cases trocar site bleeding respectively. Op. Hx(-) group had 1 inferior vena cava injury but there was no statistical difference. CONCLUSION: At the time of LAVH, the incidence of bladder injury was higher in group of patients with history of prior abdominal surgery. So special attention should be paid to prevent bladder injury.

Comparison of Total Laparoscopic Hysterectomy with Laparoscopic-Assisted Vaginal Hysterectomy and Total Abdominal Hysterectomy / 대한산부인과학회지

The objective of this study is to evaluate short-term results of total laparoscopic hysterectomy with those of total abdominal hysterectomy and laparoscopically assisted vaginal hysterectomy in a retrospective study. We compared patient's age, mean uterine weight, total operating time, length of hospital stay and perioperative hemoglobin concentration change between total laparoscopic hysterectomy (300 patients) and total abdominal hysterectomy (100 patients) and laparoscopically assisted vaginal hysterectomy (52 patients). There were no differences in terms of patient's age, parity between the three groups. There were 7 minor complications in the laparoscopically assisted vaginal hysterectomy group compared with 9 minor complications in the abdominal hysterectomy group and 14 minor complications in the total laparoscopic hysterectomy group (P not significant). The length of hospital stay was significantly shorter for total laparoscopic hysterectomy than laparoscopically assisted vaginal hysterectomy and total abdominal hysterectomy (p<.001). This study demonstrates that laparoscopic-assisted vaginal hysterectomy and total laparoscopic hysterectomy appears to be as safe as laparotomy and may replace abdominal hysterectomy in most patients and generally has the advantage of shorter hospital stay and earlier return to normal activities.

Clinical Evaluation on 30 cases of Laparoscopically Assisted Vaginal Hysterectomy for Uteri Weighing 500 g or more / 대한산부인과학회지

OBJECTIVE: To determine the feasibility and safety of performing laparoscopically assisted vaginal hysterectomy (LAVH) for uteri weighing 500 g or more and evaluate the advantages and complications of LAVH. METHODS: A subpopulation of 30 women with uteri weighing 500 g or more from group of 412 patients undergoing LAVH between Mar, 2003 to Feb, 2005. We reviewed medical records and analyzed these cases about age, parity, history of previous abdominal surgery, preoperative indications, postoperative pathologic diagnosis, mean operation times, weight of extracted uterus, change of hemoglobin, hospital stay, and complications. RESULTS: The mean age was 44.8+/-3.88 years. The mean parity was 1.78+/-0.76. Previous operation history was 16 cases (53.3%). The most common indication of operation was palpable abdominal mass. The most common pathologic diagnosis was leiomyoma. The mean operation time was 126.40+/-39.30 minutes. The mean weight of uterus was 621.23+/-107.28 g. The mean hemoglobin change was 1.57+/-1.14 g/dL. The mean hospital stay was 3.74+/-0.88 days. The only complication of operation was superficial trocar site bleeding (1 case). CONCLUSION: LAVH is a safe and effective alternative to total abdominal hysterectomy of the uteri weighing 500 g or more in selective groups.

The Effectiveness of a Preoperative Use of Misoprostol in Laparoscopically Assisted Vaginal Hysterectomy / 대한산부인과학회지

OBJECTIVE: To investigate the effectiveness of a single preoperative dose of rectal misoprostol in laparoscopically assisted vaginal hysterectomy (LAVH). METHODS: Between October 2003 and July 2004, 63 patients underwent LAVH with a single preoperative dose of rectal misoprostol 400 microgram at Grace women's hospital. To compare efficacy of a single preoperative dose of rectal misoprostol, 63 patients underwent LAVH without misoprostol were sampled during same period at Grace women's hospital. Clinicopathological variables were collected from the review of medical record and compared between two groups. Included variables were age, parity, BMI, uterus weight, largest myoma diameter, operation time, 24 hr Hb change, blood loss during operation, postoperative morbidity and postoperative complication. Associations between variable were studied using paired t-test. RESULTS: There were no significant differences in age, parity, BMI, uterus weight, largest myoma diameter between each groups. Comparing each groups in operative outcomes, estimated blood loss (155.0 +/- 97.8 mL vs 220.1 +/- 82.5 mL) and 24 hr Hb change (1.10 +/- 0.53 g/dL vs 1.57 +/- 0.46 g/dL) were significantly reduced in misoprostol group. CONCLUSION: A single preoperative dose of rectal misoprostol is a simple, reliable method for reducing intraoperative blood loss in LAVH.

Clinical Evaluation on 160 Cases of Laparoscopically Assisted Vaginal Hysterectomy (LAVH) / 대한산부인과학회지

OBJECTIVE: To report our clinical outcome on 160 cases of laparoscopically assisted vaginal hysterectomy (LAVH) and to evaluate the efficacy and safety of LAVH. METHODS: From May, 1998 to April 2004, 160 patients were performed LAVH at the Department of Obstetrics and Gynecology, Dankook University Hospital. We retrospectively analyzed the results with regard to age, parity, height, weight, previous operation history, preoperative indication, combined operation, operation time, uterine weight, change of hemoglobin, hospitalization, convert to total abdominal hysterectomy (TAH), and complication. RESULTS: The mean age was 44.63 +/- 6.79 years, The mean parity was 2.34 +/- 1.18. The common previous operations were tubal ligation (54%) and appendectomy (17%). The common preoperative indications were myoma (75%) and adenomyosis (10%). The most common combined operation was unilateral salpingoophorectomy (39%). The mean operation time was 97.81 +/- 29.90 minutes, and the mean uterine weight was 215.59 +/- 89.97 g. The mean hemoglobin change was 2.08 +/- 1.34 g/dL, and the mean hospitalization was 4.45 +/- 0.71 days. The complications were bladder injury (1 case), rectum injury (1 case), subcutaneous hematoma (2 cases), hemoperitoneum (1 case). CONCLUSION: LAVH is effective and safe alternative to TAH in many cases of gynecologic surgery. LAVH has been possible to replace TAH with improvement of surgical skill and laparoscopic instruments.

Comparative Study of Laparoscopically Assisted Vaginal Hysterectomy (LAVH) and Total Laparoscopic Hysterectomy (TLH) / 대한산부인과학회지

OBJECTIVE: To compare the clinical results between laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH), and to realize the merits and demerits of both operations, so we know which pelviscopic hysterectomy operation is better method at the present time. METHODS: 30 of LAVH cases and 30 of TLH cases were performed from 12 December 2002 to 25 February 2004 at department of OB and GY, Dankook University Hospital. We analyzed the results with regard to patient's characteristics, indication of hysterectomy, size of uterus, operation time, blood loss, duration of hospitalization and complications. RESULTS: LAVH operations, and TLH operations were performed by same operator respectively. There were no significant differences in patient's characteristics (age, height, weight) between the two groups. The main preoperative indication was myoma uteri in both groups, followed by CINIII in LAVH groups and adenomyosis in TLH groups. The majority of uterine size on operation field was adult fist size in both groups. The mean operation time was 86.3 +/- 19.5 min for LAVH group and 153.3 +/- 44.4 min for TLH group, the operation time is significantly longer in TLH group (P-value0.05). The duration of hospitalization was not significantly different between the two groups (6.1 +/- 0.4 days for LAVH, 6.2 +/- 0.8 days for TLH, P-value>0.05). There is no complication in LAVH group, 3 complications in TLH group. CONCLUSION: LAVH has no significant differences in patient's characteristics, indication of operation, size of uterus, blood loss and duration of hospitalization, compared with TLH, but it has the merits of short operation time and less complication. In this study we consider that LAVH operation method stands at advantage over TLH.

Laparoscopic Hysterectomy for Large Uterus:A Report of 86 Cases / 中国微创外科杂志

Objective To investigate the operative skills of laparoscopic hysterectomy of large uterus.Methods A retrospective analysis was conducted on clinical data from 86 cases whose uterus were bigger than twelve gestational age uterus and therefore treated with laparoscopic hysterectomy from February 1998 to December 2005.Among the 86 cases,12 received total laparoscopic hysterectomy(TLH),59 received laparoscopic supracervical hysterectomy(LSH),and 15 received laparoscopic-assisted vaginal hysterectomy(LAVH).The location of laparoscopy was determined to be at least 3-5 cm above the fundus of uterus.The most crucial step was the treatment of adnexa and uterine blood vessels.After blocking the uterine blood vessels,most of uterine bodies were rotarily cut in TLH and LAVH.Results All operations(86 cases)were performed successfully under laparoscopy and no severe operative complications were noticed except for 1 case of subcutaneous emphysema.The average operation time and the intra-operative blood loss were(92.3 ?33.5)min and(113 ?31)ml respectively.The average postoperative hospital stay was(4.1?0.3)days.No postoperative complication was found in all cases during the 6-month follow-up.Conclusions Laparoscopic hysterectomy of large uterus is safe and feasible,and does not increase operative risk and incidence of complications,when suitable laparoscopic location is selected and treatments of adnexa and uterine vessel are well performed.

Clinical Comparisons of Laparoscopic Assisted Vaginal Hysterectomy and Total Abdominal Hysterectomy in the Huge Uterine Myoma / 대한산부인과학회잡지

OBJECTIVE: This study is to evaluate the effectiveness and the value of laparoscopic assisted vaginal hysterectomy (LAVH) and the possibility of replacing total abdominal hysterectomy (TAH) to LAVH. METHODS: Retrospective study of 25 cases of LAVH and 157 cases of TAH for huge uterine myoma (uterus weight 500 gram) in Dept. of OB/GYN, Kyungpook National University Hospital from Jan. 1998 to May. 2000 was carried out and postoperative results were compared between 2 methods. Statistical analysis was performed using x2 test and Student t-test as appropriate. Statistical significance was defined as p0.05). The mean operating time was 126+/-53 (range 53-240) min vs 109+/-29 (range 60-250) min (p>0.05). The mean weight of uterus was 719+/-389 (range 500-2414) gram vs 791+/-541 (range 500- 4700) gram (p>0.05). The mean of hospital stay was 4.3+/-1.1 (range 3-8) days vs 6.9+/-3.4 (range 4-25) days (p0.05). Postoperative hospital stay was significantly shorter in LAVH than TAH. CONCLUSION: Even though fewer cases have been done, there was no episode of changing the surgery from LAVH to TAH in huge uterine myoma operation. For the more, neither was increase of morbidity compared to TAH. In huge uterine myoma operation, LAVH may replace the role of TAH in limited number of cases we have experienced. The advantages of LAVH are cosmetic superiority and early hospital discharge. In hands of experienced laparoscopic operator, huge uterine myoma is not an absolute contraindication of LAVH.

The Value of Laparoscopic Assistance in Total Vaginal Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate value of laparoscopic assistance during total vaginal hysterectomy, and its implications for hysterectomy method. METHODS: Between January 2001 and December 2001, 236 patients underwent transvaginal hysterectomy (TVH) or Laparoscopic assisted vaginal hysterectomies (LAVH) for benign disease. We compared the results of the two methods, taking account of age, parity, past history of abdominal surgery, surgical indication, operation time, blood loss, presence of pelvic adhesion, weight of uterus, and intra- and post- operative complications and hospital stays. RESULTS: There was no difference in patients' mean age, parity, or menopausal status. Previous operation history was similar between the two groups, except previous cesarean section history. Indications for surgery were similar between the two group. There was no statistical difference on preoperative hemoglobin, postoperative hemoglobin, and 1st day hemoglobin drop. However, mean blood loss checked in operation room was greater for the LAVH group (TVH:113.7+/-83.9 cc, LAVH:146.1+/-113.3 (p<0.05). Uterine weight was heavier in the laparoscopic (249.6 gm) than the vaginal group (214.8 gm) (p<0.05). Mean operating time was shorter in the vaginal (46.5 min) than the laparoscopic group (84.9 min). In laparoscopic group, 15 patients had pelvic adhesions. Four of the 15 patients had adhesions between the posterior surface of the uterus and the bowel, and successful laparoscopic adhesiolysis was achieved in all four cases. CONCLUSION: LAVH have longer operation times and hopital stays than vaginal hysterectomies, but can be safer procedures in patients with possible pelvic adhesions.

The Efficacy of Routine Hysteroscopy before Laparoscopic Assisted Vaginal Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: Recent advances in laparoscopic surgery have allowed to substitute Laparoscopic Assisted Vaginal Hysterectomy for classical abdominal hysterectomy. The purpose of this study was to evaluate the effectiveness and the value of hysteroscopic procedure which was helpful in taking directed biopsies of malignant suspected areas of endometrium before LAVH. METHODS: We compared hysteroscopic biopsy results with permanent biopsy results after LAVH in 100 patients (group A). In addition, we considered hysteroscopic biopsy results of 60 patients (group B) who had abnormal endometrial findings in vaginal ultrasonography. RESULTS: No endometrial malignant lesion was found between hysteroscopic biopsies and permanent pathologic results after LAVH in the study group A. The malignant hysteroscopic biopsy results of the study group B was about 25%. CONCLUSION: Hysteroscopic procedure for detecting endometrial malignant lesion before LAVH in large uterine tumors could be used. But this study provided that preoperative vaginal sonography was sufficient to evaluate endometrial condition.

A Clinical Study on 1594 Cases of Operative and Diagnostic Laparoscopy / 대한산부인과학회잡지

OBJECTIVE: Laparoscopic surgery provides patients with the benefits of shortened hospital stay and faster return to normal activity. The objective is to evaluate the efficacy of laparoscopic surgery in gynecologic patients. METHODS: From January, 1999 to December, 2002, total 1594 patients were performed laparoscopic surgery at Uijongbu St. Mary's Hospital. We reviewed the medical record and analyzed these cases about age, parity, diagnosis, name of operation, operation time, duration of hospitalization and side effect. RESULTS: The results of this study summarized as follows: 1. The mean age of patients was 34.0 years old and the great incidence occurred in 26-30 years old group (24.7%). 2. The average parity of patients was 1.05. 3. The common indications were ovarian cyst (34.4%), myoma uteri (19.1%), infertility (9.5%), ectopic pregnancy (15.0%), etc. In diagnostic pelviscopy, the most common indication was infertility (50.6%), and ovarian cyst (38.3%) was the most common indication in operative pelviscopy. 4. The major types of operative pelviscopy were cystectomy, LAVH, TLH, salpingectomy, adnexectomy, electrocauterization. 5. The mean duration of hospitalization was 3.72 days. 6. The major complication of surgery were intestinal injury, postoperative paralytic ileus, bleeding at resection site, but they were controlled without difficulty. CONCLUSION: Pelviscopic surgery is useful and recommended for the treatment of gynecologic disease, because this is safe and has many advantages.

Comparative Study of Laparoscopically Assisted Vaginal Hysterectomy (LAVH) and Total Abdominal Hysterectomy (TAH) / 대한산부인과학회잡지

OBJECTIVE: To compare the clinical results between laparoscopically assisted vaginal hysterectomy (LAVH) and total abdominal hysterectomy (TAH). METHOD: 60 of LAVH cases and 60 of TAH cases, which were performed at Dankook university hospital from April 1998 to December 2000. We analyzed the results with regard to patient's characteristics, indication of hysterectomy, weight of uterus, operation time, blood loss, hospital stay and complications. RESULTS: Total 120 of hysterectomy cases (60 LAVH, 60 TAH) were enrolled in this study. All operations, LAVH and TAH, were performed by same surgeon. There were no significant differences in patient's characteristics (age, height, weight, parity) between the two groups. The main preoperative indication was myoma uteri, followed by adenomyosis, CIN III, for both LAVH and TAH. The mean uterine weight of TAH cases was larger than LAVH (214.8+/-88.1 gm for LAVH, 377.1+/-269.0 gm for TAH, p0.05). The hospital stay of LAVH was significantly shorter than TAH (4.9+/-0.6day for LAVH, 7.5+/-1.9day for TAH, p<0.05). CONCLUSION: In the comparison of LAVH and TAH operation, we conclude that LAVH can be considered as the first choice when determining hysterectomy method, unless contraindication prevents it. LAVH has advantages of shorter hospitalization and the acceptable complication rate.

A Clinical Study of 215 Cases of Pelviscopic Surgery in Gynecologic field / 대한산부인과학회잡지

OBJECTIVE: To evaluate the scope of pelviscopic surgery on gynecologic disease, safety or efficacy associated with the procedure. METHODS: Two hundred fifteen cases of pelviscopic surgery which were performed at Dankook University Hospital from March 1998 to February 2002. All cases were analyzed with regard to the age, parity, indications for surgery, types of the surgery, past history of surgery, operation time, hospital days, intra and postoperative complications. RESULTS: The mean age of patient was 39.2 years, the mean number of parity was 1.8. The most common clinical indication of the surgery was ovarian tumor 106 cases (50.2%), followed by myoma uteri 80 cases (37.2%), CIN III 14 cases (6.5%). The types of surgery were LAVH 93 cases (43.3%), salpingo-oophorectomy 61 cases (28.4%), oophorectomy 34 cases (15.8%). The operation time ranged 20 to 200 minutes and the mean duration of hospitalization was 4.4 days. CONCLUSION: The pelviscopy offers the advantages of reduced surgical morbidity, less bleeding, less postoperative pain, shorter hospital stays. Pelviscopic operation is safe and effective alternative to laparotomy in many cases of gynecologic surgery.