LAVH or TAH - choosing it wise and making it safe
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Background: Hysterectomy is the most commonly performed surgery in our gynaecological practice, abdominal route being the most common. Here we compare the various features and outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) with total abdominal hysterectomy (TAH).Methods: The study design is a retrospective observational study. Outcome measures were indication, duration, complications of surgery, post op recovery and cost following TAH and LAVH.Results: A total of 116 cases underwent hysterectomy. Of these 98 underwent TAH and 18 underwent LAVH. Commonest indication for TAH in our study was fibroid followed by abnormal uterine bleeding (AUB); whereas in LAVH it was AUB followed by fibroid. Mean operating time in TAH was 118 minutes whereas in LAVH it was 166 minutes. One patient who underwent LAVH had ureteric injury and another had vault abscess. There were no major complications among TAH cases. A few patients had minor complications like fever, wound infection and urinary tract infection following TAH whereas fever was the only minor complication seen in a minority of the LAVH patients. Mean fall in haemoglobin in TAH was 1.05 gm% whereas in LAVH it was 0.95 gm%. None of the patients required postoperative blood transfusion. A few patients following TAH required additional analgesics apart from routine whereas in LAVH none required it. Mean duration of hospital stay following TAH was 6.84 days where as in LAVH it was 3.1 days. Mean hospital expenses in TAH were INR 28480, while for LAVH it was 44360.Conclusions: Undoubtedly expertise is the decisive factor behind the success of hysterectomy. LAVH though advantageous in many aspects like less post operative pain and cosmetic benefits, it could be technically demanding with availability only in well-equipped centres and cost factors. Surgeons need to be trained in all modalities of hysterectomy.Keywords:
Postoperative fever
Abdominal hysterectomy
Abdominal hysterectomy
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SummaryA partial hysterectomy technique is described which aims to reduce tissue trauma and speed recovery. The first 50 women who underwent this supravaginal hysterectomy were compared with 50 who had a routine total abdominal hysterectomy. The groups were not allocated at random. The supravaginal hysterectomy involved shorter operating time (45 minutes versus 57 minutes mean), and a shorter stay in hospital. Although no differences in urinary symptoms were noted, sexual satisfaction following the supravaginal procedure was found to be more than after the total abdominal hysterectomy.
Abdominal hysterectomy
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Abstract The basic procedure of abdominal hysterectomy is extrafascial hysterectomy, and intrafascial hysterectomy (Aldridge operation) and retrograde hysterectomy are performed as applied surgical procedures. The Aldridge operation and retrograde hysterectomy are performed when strong adhesion is present around the uterus. Retrograde hysterectomy is also useful when the cervicovaginal junction is not clearly felt by palpation, such as when uterine rupture immediately occurs after vaginal delivery or when a large tumor mass is present in the vagina.
Palpation
Abdominal hysterectomy
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Hysterectomy can be successfully conducted by a number of approaches,currently including total abdominal hysterectomy,subtotal abdominal hysterectomy,abdominal fascial hysterectomy,total vaginal hysterectomy,modified total vaginal hysterectomy,modified pelvic floor strengthening total vaginal hysterectomy,laparoscopic assisted vaginal hysterectomy,classic intrafacial SEMM hysterectomy and total laparoscopic hysterectomy.However,every approach has its pros and cons.Here is to review the recent literature to provide some guidelines for choosing the most appropriate operation approach.
Abdominal hysterectomy
Laparoscopic hysterectomy
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Abdominal hysterectomy
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Cervical conization
Abdominal hysterectomy
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Between 1990 and 1995 in Australia, the use of abdominal hysterectomy decreased from 78 to 57% of all hysterectomies. This was due to an increase in the use of vaginal hysterectomy from 22 to 35% and the introduction of laparoscopic hysterectomy, which accounted for 8% of cases in 1994–95. Surgeons skilled in hysterectomy techniques perform abdominal hysterectomy in less than 10% of cases, because of their high rates of use of vaginal or laparoscopic hysterectomy or of both. At 4–8%, general utilization of laparoscopic hysterectomy is low in the UK, USA and Australia, and limitations in learning laparoscopic hysterectomy technique are evident. Strategies to simplify the technique have developed but their general application has yet to be demonstrated.
Abdominal hysterectomy
Laparoscopic hysterectomy
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Objectives: This study was to compare two routes of hysterectomy for benign uterine conditions of < 12 weeks in respect to duration of surgery, complications, requirement for blood transfusion and hospital stay between abdominal and vaginal route of hysterectomy. Material & methods: This was a prospective interventional single centre study on 100 consecutive patients (50 patients in each group) who underwent hysterectomy for benign uterine conditions either by Non-Descended Vaginal Hysterectomy or by Total Abdominal Hysterectomy route. Results: For Non Descended Vaginal Hysterectomy, operative time (47.08 ±5.8 minutes) vs. (61.02± 5.51minutes) (p Value -
Abdominal hysterectomy
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To compare the costs of vaginal and abdominal hysterectomy with robotically assisted hysterectomy.We identified all cases of robotically assisted hysterectomy, with or without bilateral salpingo-oophorectomy, treated at the Mayo Clinic (Rochester, Minnesota) from January 1, 2007, through December 31, 2009. Cases were propensity score-matched (one-to-one) to cases of vaginal and abdominal hysterectomy, selected randomly from January 1, 2004, through December 31, 2006 (before acquisition of the robotic surgical system). All billed costs were abstracted through the sixth postoperative week from the Olmsted County Healthcare Expenditure and Utilization Database and compared between cohorts with a generalized linear modeling framework. Predicted costs were estimated with the recycled predictions method. Costs of operative complications also were estimated.The total number of abdominal hysterectomies collected for comparison was 234 and the total number of vaginal hysterectomies was 212. Predicted mean cost of robotically assisted hysterectomy was $2,253 more than that of vaginal hysterectomy ($13,619 compared with $11,366; P<.001), although costs of complications were not significantly different. The predicted mean costs of robotically assisted compared with abdominal hysterectomy were similar ($14,679 compared with $15,588; P=.35). The costs of complications were not significantly different.Overall, vaginal hysterectomy was less costly than robotically assisted hysterectomy. Abdominal hysterectomy and robotically assisted hysterectomy had similar costs.II.
Abdominal hysterectomy
Oophorectomy
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Objective:To evaluate the efficacy of Laparoscopicallyassisted vaginal hysterectomy.Methods:One hundred and six patients sufferedfrom benign gynecological diseases referred for abdominal hysterectomy,were treated with Laparoscopicallyassistedvaginal hysterectomy.Results:According to all of 106 cases,the surgery time was among 56 minutes to 135 minutes,with bleeding amount of 110 mL to 300 mL.The wound healed well,after 4~6 days of hospital care.Conclusions:Laparoscopicallyassisted vaginal hysterectomy gives less damage,quickly recovery,and may replace the abdominal hysterectomy sometimes.
Abdominal hysterectomy
Abdominal wound
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