Is laparoscopically-assisted vaginal hysterectomy associated with low operative morbidity?
Seventy-one consecutive patients undergoing laparoscopically-assisted vaginal hysterectomy were prospectively evaluated with particular emphasis on the operative morbidity. Bipolar desiccation was the mainstay for haemostasis. Fibroids accounted for two-thirds of the uterine pathology and the average uterine weight was 238.0 g (SD 134.6). Mean operating time was 126.3 minutes (SD 36.9) and decreased with experience despite the progressive increase in uterine weight. The mean blood loss was 432 mL (SD 288) with a mean haemoglobin change of 2.3 g/dL (SD 1.5). Intraoperative complications occurred in 5 patients (7.0%), 2 with inferior epigastric artery injuries and 3 serosal bladder injuries. Postoperative complications occurred in 45 patients (63.4%). Febrile morbidity was the major complication and occurred some 50% of patients, 45% of whom had no underlying cause identified. Vault haematoma was the second most common complication and occurred in 31.0%. The mean hospital stay was 5.4 days (SD 2.7) and the readmission rate was 10%. Our results of laparoscopically-assisted vaginal hysterectomy did not conform with the benefits of reduced blood loss, shorter hospital stay and reduced postoperative complications reported in the literature. The true complication rate of laparoscopically-assisted vaginal hysterectomy should be carefully assessed before this can be considered as the approach of choice to hysterectomy.
Yuen
P M
PM
Department of Obstetrics and Gynaecology, Chinese University of Hong Kong.
Rogers
M S
MS
D000328:Adult; D016063:Blood Loss, Surgical; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects; D007889:Leiomyoma / Q000601:surgery; D007902:Length of Stay; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications; D011446:Prospective Studies; D014592:Uterine Hemorrhage / Q000209:etiology; D014594:Uterine Neoplasms / Q000601:surgery