Laparoscopic-assisted vaginal hysterectomy with bilateral oophorectomy versus total abdominal hysterectomy and bilateral salpingo-oophorectomy--implications for gynecologic practice in the United Kingdom.
A prospective, randomized study was conducted to identify differences in the perioperative outcome of patients undergoing either routine total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) or laparoscopic-assisted vaginal hysterectomy and bilateral salpingo-oophorectomy (LAVH-BSO). We also assessed potential management implications, including financial differences, between the operations. Of 40 women requiring hysterectomy for a range of benign conditions, 20 underwent LAVH-BSO and 20 TAH-BSO. The respective mean operating times were 97.5 and 54 minutes. Patients in the former group required significantly less postoperative oral analgesia, 4.1 doses compared with 11.7 doses on average. The length of postoperative stay was shortened from 6 to 3.8 days on average for LAVH-BSO. The potential cost savings was 17.9% per case for LAVH-BSO compared with TAH-BSO. Thus, LAVH-BSO was a safe alternative to TAH-BSO, with less morbidity and earlier hospital discharge. Possible cost savings suggest the need for changes to current operating and inpatient hospital resources.
Raju
K S
KS
St. Thomas' Hospital, London SE1 7EH, United Kingdom.
Auld
B J
BJ
D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D005187:Fallopian Tubes / Q000601:surgery*; D005260:Female; D006176:Gynecology / Q000191:economics / Q000379:methods*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000191:economics / Q000379:methods; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods; D007902:Length of Stay; D008875:Middle Aged; D010052:Ovariectomy / Q000009:adverse effects / Q000379:methods; D010818:Practice Patterns, Physicians' / Q000191:economics; D011446:Prospective Studies; D016896:Treatment Outcome; D006113:United Kingdom