A comparison of laparoscopic supracervical hysterectomy vs laparoscopically assisted vaginal hysterectomy.
BACKGROUND
We set out to compare the length of stay, costs, and morbidity associated with laparoscopic supracervical hysterectomy (LSH) with laparoscopically assisted vaginal hysterectomy (LAVH).


METHODS
We performed a cohort analysis of consecutive patients at a university-based medical center from April 1997 through October 1999.


RESULTS
A total of 145 patients were identified initially; however, 13 cases were excluded because of concomitant procedures (retropubic urethropexy, lymphadenectomy, paravaginal repair). Of the 132 patients included in the study, 27 underwent LSH and 105 underwent LAVH. The two groups were similar with respect to gravidity, parity, uterine weight, and preoperative diagnosis. Patients undergoing LSH had significantly shorter operating times (median, 181 vs 220 min, p = 0.007), briefer hospital stays (median, 1.0 vs 2.0 days, p = 0.0001), and less blood loss (median, 125 vs 400 ml, p = 0.0001). None of the patients submitted to LSH experienced morbidity, as compared with a 13% morbidity rate for LAVH (bladder injury, n = 3; blood loss >1000 ml, n = 7; vaginal cuff hematoma, n = 4; 0% vs 13%; p = 0.04).


CONCLUSIONS
Patients undergoing laparoscopic supracervical hysterectomy had shorter operating times, shorter hospital stays, and less morbidity than those who underwent laparoscopically assisted vaginal hysterectomy. The practice of routine cervicectomy at laparoscopic hysterectomy should be reconsidered.
Milad
M P
MP
Department of Obstetrics and Gynecology, Northwestern University Medical School and Northwestern Memorial Hospital, 333 East Superior Street, Chicago, IL 60611, USA.
Morrison
K
K
Sokol
A
A
Miller
D
D
Kirkpatrick
L
L
D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000379:methods*; D007045:Hysterectomy, Vaginal / Q000191:economics / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007889:Leiomyoma / Q000601:surgery; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D017699:Pelvic Pain / Q000601:surgery; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000601:surgery