title: A randomized study of total abdominal, vaginal and laparoscopic hysterectomy.
abstract: OBJECTIVE
  To evaluate operative time, blood loss and inflammatory response in patients submitted to hysterectomy.
  
  
  METHODS
  Sixty patients referred for hysterectomy were prospectively randomized to total abdominal hysterectomy (n=20), vaginal hysterectomy (n=20), or laparoscopic hysterectomy (n=20). The operative time, blood loss (variation in erythrocyte and hemoglobin) and inflammatory answer (CRP and interleukin-6 dosages) were compared by using Kruskal-Wallis, Dunn non-parametric test and variance analysis with repeated measurements.
  
  
  RESULTS
  Operative time was shorter for vaginal hysterectomy, and there was no significant difference between total abdominal hysterectomy and laparoscopic hysterectomy. Reduction in erythrocyte and hemoglobin was more noticeable after vaginal hysterectomy, followed by total abdominal hysterectomy and laparoscopic hysterectomy. CRP levels increased steadily from vaginal hysterectomy to laparoscopic hysterectomy and then to total abdominal hysterectomy. The increase in interleukin-6 was substantially higher in total abdominal hysterectomy, whereas no difference was noted between vaginal and laparoscopic hysterectomy.
  
  
  CONCLUSIONS
  Vaginal hysterectomy presents superior results in terms of operative time and inflammatory response when compared with total abdominal and laparoscopic hysterectomy and it should be the first option for hysterectomy. Laparoscopic hysterectomy should be considered when the vaginal approach is unfeasible, showing clear advantages over abdominal hysterectomy.
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical; D002097:C-Reactive Protein / Q000032:analysis* / Q000096:biosynthesis; D004715:Endometriosis / Q000601:surgery; D004906:Erythrocyte Count; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D015850:Interleukin-6 / Q000096:biosynthesis / Q000097:blood*; D010535:Laparoscopy; D007889:Leiomyoma / Q000601:surgery; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000601:surgery
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D015850:Interleukin-6; D002097:C-Reactive Protein