Laparoscopic hysterectomy in large uteri: Experience from a tertiary care hospital in Bangladesh.

INTRODUCTION: The purpose of this study was to examine the safety and feasibility of laparoscopically assisted vaginal hysterectomy for uteri weighing more than 500 g as compared to uteri weighing less than 500 g in benign gynecological diseases. METHODS: This was a retrospective study. Patients were admitted through the outpatient department. They were divided into two groups: uterine weight ≥500 g (group 1) and uterine weight >500 g (group 2). There were no exclusion criteria based on the size, number, or location of leiomyomas. The patient characteristics for the two groups were compared in terms of demographic and socioeconomic details, operating time, amount of blood loss, requirement of blood transfusion, need for analgesia, and length of hospital stay. RESULTS: The characteristics age and BMI were well balanced between the two groups. Uterine weight was 267.2 ± 97.6 g in group 1 and 740.0 ± 371.4 g in group 2 (P < 0.001). Length of operation and amount of blood loss were greater in group 2 than in group 1 (operation: 89.1 ± 26.7 vs 73.3 ± 24.6 min, P < 0.01; blood loss: 570.5 ± 503.6 vs 262.5 ± 270.0 mL, P < 0.001). However, there was no significant difference in hospital stay or incidence of operative complications between the two groups. No patients were switched from laparoscopy to laparotomy during operation. The rate of blood transfusion was lower in group1 than in group 2 (4.9% vs 32.6%; P < 0.001). CONCLUSION: This study demonstrated that despite the increased operating time and blood loss, laparoscopy should be considered instead of laparotomy in cases of large uteri. Laparoscopically assisted vaginal hysterectomy can be performed safely for a large uterus.

A Comparative Study Between Laparoscopically Assisted Vaginal Hysterectomy and Vaginal Hysterectomy: Experience in a Tertiary Diabetes Care Hospital in Bangladesh.

OBJECTIVE: The study was undertaken to compare the efficiency and outcome of Laparoscopic Assisted Vaginal Hysterectomy (LAVH) and Vaginal Hysterectomy (VH) in terms of operative time, cost, estimated blood loss, hospital stay, quantity of analgesia use, intra- and postoperative complication rates and patients recovery. MATERIALS AND METHODS: A total of 500 diabetic patients were prospectively collected in the study period from January 2005 through January 2009. The performance of LAVH was compared with that of VH, in a tertiary care hospital. The procedures were performed by the same surgeon. RESULTS: There was no significant difference in terms of age, parity, body weight or uterine weight. The mean estimated blood loss in LAVH was significantly lower when compared with the VH group (126.5±39.8 ml and 100±32.8 ml), respectively. As to postoperative pain, less diclofenac was required in the LAVH group compared to the VH group (70.38±13.45 mg and 75.18±16.45 mg), respectively. CONCLUSIONS: LAVH, is clinically and economically comparable to VH, with patient benefits of less estimated blood loss, lower quantity of analgesia use, lower rate of intra- and postoperative complications, less postoperative pain, rapid patient recovery, and shorter hospital stay.