The Value of Laparoscopic Assistance in Total Vaginal Hysterectomy / 대한산부인과학회잡지

ABSTRACT

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 (TVH113.7+/-83.9 cc, LAVH146.1+/-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.