Laparoscopic-assisted vaginal hysterectomy utilising the contact-tip Nd: YAG laser: a review of 67 cases.
The purpose of this study was to determine the efficacy of laparoscopic-assisted vaginal hysterectomy utilising the contact-tip Nd:YAG (Neodymium: Yttrium-Aluminum-Garnet) laser (Surgical Laser Technologies, Oaks, PA). Postoperative activity levels, operative times, blood loss, pain medication use, length of hospital stay, and complications of laparoscopic-assisted vaginal hysterectomy were determined. Sixty-seven women with extensive disease including endometriosis, adenomyosis, adhesions, and multiple fibroids underwent laparoscopic-assisted vaginal hysterectomy (LAVH). The procedures were performed utilising the contact-tip Nd:YAG laser and a laparoscopic linear stapling device. All patients were operated on for a primary diagnosis of pelvic pain and would have required an abdominal approach for surgery due to extensive adhesions, fibroids, or endometriosis. Sixty-eight cases of laparoscopic-assisted vaginal hysterectomy were attempted. In 67 of these cases, the procedure was completed as planned. One case required conversion to abdominal hysterectomy due to extensive adhesions. Average hospital stay after surgery was 2.7 days with a minimum stay of less than one day. The average operating time for the LAVH was 149 minutes with an estimated blood loss of 220 mL and a haemoglobin drop from surgery to day 1 after surgery of 1.9 g. The complication rate was 11.9% with all of the complications occurring in the first 46 cases. By day 14 after surgery, patients reported their activity level at 8.8 on a scale of 1 to 10 with 10 being unlimited activities. By day 21, they reported their activity level at 9.5. The majority of the patients were able to return to work within two weeks.(ABSTRACT TRUNCATED AT 250 WORDS)
Carter
J E
JE
University of California College of Medicine.
Bailey
T S
TS
D000291:Adnexal Diseases / Q000601:surgery; D000328:Adult; D016063:Blood Loss, Surgical; D004715:Endometriosis / Q000601:surgery; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods* / Q000534:rehabilitation; D010535:Laparoscopy / Q000379:methods* / Q000534:rehabilitation; D053685:Laser Therapy / Q000379:methods* / Q000534:rehabilitation; D007889:Leiomyoma / Q000601:surgery; D007902:Length of Stay; D011183:Postoperative Complications; D011184:Postoperative Period; D013997:Time Factors; D000267:Tissue Adhesions; D014594:Uterine Neoplasms / Q000601:surgery