ABSTRACT
In September 1990 we performed our first laparoscopic-assisted vaginal hysterectomy (LAVH). Operating time was 127 minutes, estimated blood loss was 400 ml, and length of hospital stay of 3 days. No surgical complications occurred. During the next 5 years, as we gained more experience, the technique changed until we arrived at our present method. In the last patient in this 5-year period, length of operating time was 72 minutes, estimated blood loss was 100 ml, and length of stay was 2 days. The shorter hospital stay was statistically significant compared with abdominal hysterectomy; the length of surgery and blood loss were not. Patient discomfort was less with LAVH. Again, no surgical complications occurred. During these 5 years we performed a total of 318 LAVHs. The procedure enabled us to reduce the number of abdominal hysterectomies to only a few. We believe that, in the hands of experienced surgeons, the outcome is better with LAVH than with the standard abdominal approach.
ABSTRACT
The first 150 consecutive laparoscopic vaginal hysterectomy (LVH) cases done by Creighton University faculty members at Mercy Hospital, Council Bluffs, Iowa and at St Joseph Hospital, Omaha, Nebraska were compared with 194 abdominal hysterectomies (AHs) for benign or noninvasive disease. The results indicate that LVH can be accomplished with low morbidity, low length of stay, and with less patient discomfort than experienced by patients who undergo AH.
Subject(s)
Hysterectomy, Vaginal/methods , Hysterectomy/methods , Laparoscopy , Adult , Aged , Blood Loss, Surgical , Female , Humans , Hysterectomy/adverse effects , Hysterectomy, Vaginal/adverse effects , Length of Stay , Middle AgedABSTRACT
Even though there are few complications with endoscopic surgery, some are life threatening. Pneumothorax is among these complications. Timely recognition and rapid diagnosis is essential. This is a case of a routine laparoscopy that was complicated by bilateral pneumothorax, and its diagnosis and treatment.
Subject(s)
Laparoscopy/adverse effects , Pneumothorax/etiology , Adult , Chest Tubes , Fallopian Tube Diseases/diagnosis , Fallopian Tube Diseases/surgery , Female , Follow-Up Studies , Humans , Ovarian Diseases/diagnosis , Ovarian Diseases/surgery , Pelvic Pain/diagnosis , Pelvic Pain/surgery , Pneumothorax/diagnosis , Pneumothorax/therapy , Thoracostomy , Tissue Adhesions/diagnosis , Tissue Adhesions/surgeryABSTRACT
For the past several years LAVH has become a more common procedure. The publication of the first laparoscopic hysterectomy in 1989 encouraged us to perform our first LAVH in October 1990. In the following three years, October 1990 to September 1993, we performed 175 LAVHs. The charts were reviewed and data for length of surgery and blood loss was obtained from anesthesia records. Indications were the same as for vaginal hysterectomy. The average age for the patient was 42 years with a range of 23 to 73 years. The range of uterine weight was 41 to 462 gms, with an average of 158 gms. Length of surgery was an average of 109 minutes with a range of 53 minutes to 420 minutes. Length of stay ranged from one to five days with an average of 2.3 days and 2.1 days when patients with bladder repair were excluded. Blood loss average was 302 ml. Only two major complications occurred. One patient had a bladder laceration and one had to undergo exploratory laparotomy because of inability to achieve hemostasis from the right vaginal angle. She was the only patient to require blood transfusion.
ABSTRACT
The first 115 laparoscopically assisted vaginal hysterectomies (LAVH) done by our faculty surgeons were compared with 220 vaginal hysterectomies (VH) and 194 abdominal hysterectomies (AH) done in our affiliated hospitals over the same period of time. Logistic regression analysis indicates that LAVHs were done for cases that would significantly be more likely selected for AH than for VH (p less than 0.0001). Matched case control studies with 28 LAVH/VH and 34 LAVH/AH pairs and bivariate analyses demonstrated that LAVH can be accomplished with low morbidity, short lengths of stay, and little, if any, increase in operating times compared with VH and AH. The LAVH procedure can be expected to replace many AHs in the future.
Subject(s)
Hysterectomy/methods , Laparoscopy/methods , Adolescent , Adult , Age Factors , Aged , Body Weight , Case-Control Studies , Female , Humans , Hysterectomy/adverse effects , Hysterectomy/standards , Laparoscopy/adverse effects , Laparoscopy/standards , Length of Stay , Logistic Models , Middle Aged , Morbidity , Risk FactorsABSTRACT
Laparoscopic management of ectopic pregnancies is the accepted method of treatment in most centers. This report describes a case of persistent trophoblastic implants to the peritoneum after laparoscopic linear salpingostomy for evacuation of an early ectopic pregnancy. Based on this experience, methods for follow up after such procedures, and recommendations for management of persistent trophoblastic implants are discussed.
Subject(s)
Laparoscopy , Peritoneal Neoplasms/pathology , Pregnancy, Tubal/surgery , Salpingostomy/adverse effects , Trophoblasts/pathology , Adult , Electrocoagulation , Female , Humans , Laparotomy , Peritoneal Neoplasms/surgery , PregnancyABSTRACT
Patients who underwent laparoscopy-assisted vaginal hysterectomy with or without adnexectomy experienced less fever, required less postoperative analgesia, were able to tolerate a full diet within 24 hours of surgery, and had a faster recovery and shorter hospital stay than patients who had abdominal or traditional vaginal hysterectomy.
