Experience with laparoscopic assistance in vaginal hysterectomy.
OBJECTIVE
To determine safety and usefulness of laparoscopy intended to convert an abdominal into a vaginal hysterectomy.


METHODS
Forty-seven consecutive hysterectomies are retrospectively analyzed in which laparoscopy was used to accomplish a vaginal instead of an abdominal procedure which would have been performed without endoscopic surgery.


RESULTS
In four patients the operation had to be converted to laparotomy due to difficult access (n = 3) or heavy bleeding (n = 1). Operation time declined during the study period, thus highlighting the importance of experience with laparoscopic technics. Major complications such as injuries of adjacent organs or delayed haemorrhage requiring a second intervention were not encountered.


CONCLUSIONS
Laparoscopy in hysterectomy seems to be a valuable method to avoid laparotomy. In the future, guidelines to determine the route of surgery are to be established which include those conditions in which laparoscopy in addition to vaginal hysterectomy implies a benefit for the patient.
Rempen
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Universitäts-Frauenklinik, Würzburg, Germany.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal; D010535:Laparoscopy; D007813:Laparotomy; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome