Converting Potential Abdominal Hysterectomy to Vaginal One: Laparoscopic Assisted Vaginal Hysterectomy

Background. The idea of laparoscopic assisted vaginal hysterectomy (LAVH) is to convert a potential abdominal hysterectomy to a vaginal one, thus decreasing associated morbidity and hastening recovery. We compared intraoperative and postoperative outcomes between LAVH and abdominal hysterectomy, to find out if LAVH achieves better clinical results compared with abdominal hysterectomy. Material and methods. A total of 48 women were enrolled in the study. Finally 17 patients underwent LAVH (cases) and 20 underwent abdominal hysterectomy (controls). All surgeries were performed by a set of gynecologists with more or less same level of surgical experience and expertise. Results.None of the patients in LAVH required conversion to laparotomy. Mean operating time was 30 minutes longer in LAVH group as compared to abdominal hysterectomy group (167.06 + 31.97？min versus 135.25 + 31.72 min; ). However, the mean blood loss in LAVH was 100？mL lesser than that in abdominal hysterectomy and the difference was found to be statistically significant (248.24 + 117.79？mL versus 340.00 + 119.86？mL; ). Another advantage of LAVH was significantly lower pain scores on second and third postoperative days. Overall complications and postoperative hospital stay were not significantly different between the two groups. 1. Background Hysterectomy is the second most frequently performed major surgical procedure on women all over the world, next only to cesarean. The term “hysterectomy” though means removal of uterus; in practice it has a much wider classification depending upon the indication. At times, it is done without removal of the cervix (supracervical hysterectomy) or with removal of adnexa (hysterectomy with salpingooophorectomy). It can also be a part of staging laparotomy or radical hysterectomy. Hysterectomy can be performed abdominally, vaginally, or through abdominal ports with help of laparoscope. Approach depends on surgeon’s preference, indication for surgery, nature of the disease, and patient characteristics. As any other surgery, hysterectomy is also associated with intraoperative and postoperative complications. Rates of various complications with hysterectomy have been reported in the range of 0.5% to 43% [1]. There is enough evidence from multiple randomized trials that vaginal hysterectomy is associated with fewer complications, a shorter hospital stay, more rapid recovery, and lower overall cost [2]. The idea of laparoscopic assisted vaginal hysterectomy (LAVH) is to convert a potential abdominal hysterectomy to a vaginal one, thus decreasing associated