[Operating time of laparoscopically assisted vaginal hysterectomy (LAVH)--the causative factors and the course of the postoperative period]. / Czas trwania LAVH--czynniki sprawcze i przebieg okresu pooperacyjnego.

OBJECTIVES: The aim of the study was to find the causative factors of prolongation of the operating time of laparoscopically assisted vaginal hysterectomy (LAVH) and to analyse the influence of the operating time on the course of the postoperative period. MATERIAL AND METHODS: Retrospective analysis of 103 LAVH procedures performed from June 2002 to April 2006 for benign conditions. All the cases have been divided in two groups, depending on the operating time: 45 procedures up to 90 minutes (average 76, range 50-90) and 58--over 90 minutes (average 126, range 95-210). In both groups we have analysed patient characteristics, indications, uterine size, intra- and postoperative complications, blood loss, hospital stay, the day of the return to the general diet, anaesthetic and antibiotic demand in postoperative period. RESULTS: There were 42.2% of postmenopausal patients in the "short-time" LAVH group and 17.2% in the "long-time" LAVH group (p < 0.05). 8.9% women in the short LAVH group and 31.0% in the long LAVH group had had no vaginal deliveries (p < 0.05). There was no significant difference in previous surgery history between the groups. Significant correlation of operating time of LAVH with patient weight (r = 0.26, p < 0.01) and BMI (Body Mass Index) (r = 0.21, p < 0.05) was noted. Uterine size was bigger in the long LAVH group (p < 0.01). There was one intraoperative complication (bowel injury) and three postoperative ones (two cases of bleeding to abdominal cavity demanding reoperation and one to the abdominal wall from injured superficial epigastric artery), all occurred in the long LAVH group. The average perioperative decrease in haemoglobin concentration was insignificantly higher in the long LAVH group (2.0 g% vs 1.4%). There was 4.4% rate of antibiotic demand after the short LAVH procedures and 24.1% after the long ones (p < 0.05). There was no significant difference in anaesthetic demand. The average day of introducing the general diet was 1,0 (range 1-2) in the short LAVH group and 1,4 (range 1-5) in the long LAVH group (p < 0.05). The average hospital stay was 2,6 days after the short LAVH procedures and 3,3 days after the long ones (p < 0.05). CONCLUSIONS: The operating time of LAVH depends on operator experience, obstetric history, presence or absence of the menstrual cycles, uterine size and, probably, patient weight and BMI. After the long LAVH procedure antibiotic use is more common, return to the general diet takes place later and hospital stay is prolonged.

[Anterior approach sacrospinous colpopexy in a patient with vaginal vault prolapse, stress urinary incontinence and cystocoele with lateral defect]. / Kolpopeksja krzyzowo-kolcowa z dostepu przedniego u pacjentki z wypadaniem kikuta pochwy wysilkowym nietrzymaniem moczu oraz cystocoele z defektem bocznym.

We present a case of vaginal vault prolapse after hysterectomy associated with cystocoele with central and lateral defect and stress urinary incontinence, that was treated surgically with employment of sacrospinous colpopexy through anterior approach (from paravesical space), combined with anterior colporrhaphy by double TOT approach method (that is a butterfly-shaped polipropylen mesh, which arms were carried through upper and lower parts of obturator foramens by tension-free method). There were no postoperative complications. A control examination at 1 and 3 months after the operation showed maintenance of normal anatomic relations, which were obtained as a result of repair, total control of urinary continence and full patient's satisfaction from the operation.

[Significance of laparoscopic assistance in vaginal hysterectomy]. / Znaczenie wspomagania laparoskopowego w operacji usuniecia macicy przez pochwe.

OBJECTIVE: The objective of this publication was the analysis of laparoscopically assisted vaginal hysterectomies (LAVH) performed in Department of Surgical and Endoscopic Gynecology of Polish Mother Health Centre Research Institute. MATERIALS AND METHODS: There was the analysis of 57 LAVHs performed from June 2002 to December 2003. Following parameters were evaluated: indications to LAVH, operating time, weight of the removed uterus, complications, blood loss, duration of postoperative hospitalisation, the day of introducing general diet, anesthetic and antibiotic demand in postoperative period. RESULTS: There were indications to LAVH: fibroid uterus, endometrial hyperplasia, endometrial cancer, adnexal mass, cervix dysplasia. Previous laparotomy and caesarean section, endometriosis, narrow vagina of non-parous women were additional indications to use of laparoscopy during the operation. Complications were found in two (3,5%) cases: bleeding to abdominal cavity from infundibulo-pelvic ligament demanding reoperation and superficial epigastric artery injury no demanding reoperation. There were no infection, conversion to laparotomy, abdominal cavity organs injury and other complications. It was observed short time of introducing general diet, low anesthetic consumption and short post-operation stay in hospital (mean 3,6 days). CONCLUSIONS: Laparoscopically assisted vaginal hysterectomy is an operation with a small risk of intra- and postoperative complications, quick return to general diet and full life activity, short post-operation stay in hospital, low anesthetic consumption and good cosmetic effect. Use of laparoscopic stage in vaginal hysterectomy make possible evasion of laparotomy in the situation of impossible performance of ordinary vaginal hysterectomy.