Comparison of total laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy, total abdominal hysterectomy and vaginal hysterectomy / Монголын Анагаах Ухаан

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; VH51.6 +/-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;TAH6.5+/-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.