title: Observational comparison of abdominal, vaginal and laparoscopic hysterectomy as performed at a university teaching hospital.
abstract: OBJECTIVE
  To compare short-term outcomes of total abdominal hysterectomy (TAH) to total vaginal hysterectomy (TVH) and laparoscopic hysterectomy (LH) regarding operative time, estimated blood loss, postoperative pain, recovery milestones, complication rates, hospital stay, hospital costs and patient satisfaction.
  
  
  METHODS
  A prospective, observational study examined the above criteria for 177 women with the following distribution of hysterectomy type: TAH (n = 50, 28%), TVH (n = 76, 43%) and LH (n = 51, 29%).
  
  
  RESULTS
  Operative time was shortest for TVH (103 minutes), followed by TAH (127 minutes), and longest for LH (157 minutes) (p = 0.000). Blood loss was significantly higher in the TAH groups as compared to the TVH and LH groups. Pain estimates and analgesia requirements were significantly lower for the LH and TVH groups as compared to the TAH group. Recovery milestones were met significantly earlier in the TVH and LH groups. Complication rates did not differ significantly between the groups. Hospital stay was significantly longer for the TAH group (3.7 days) than for the TVH (1.9 days) and LH (1.5 days) groups. Hospital costs were significantly lower for the TVH groups as compared to TAH and LH groups. No significant cost difference was seen between TAH and LH. Satisfaction rates did not differ significantly between the groups though a greater percentage of patients in the LH group reported high satisfaction as compared to the other groups.
  
  
  CONCLUSIONS
  Vaginal hysterectomy remains the most cost-effective approach; laparoscopy's role may be best suited to allowing conversion of laparotomy cases to a vaginal approach with assistance of a laparoscope.
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, University of Louisville School of Medicine, 550 South Jackson Street, Louisville, KY 40292, USA.
authors.forename: Allam
authors.initials: A
authors.lastname: Abdelmonem
authors.forename: Heather
authors.initials: H
authors.lastname: Wilson
authors.forename: Resad
authors.initials: R
authors.lastname: Pasic
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D016063:Blood Loss, Surgical; D005260:Female; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000379:methods*; D007045:Hysterectomy, Vaginal / Q000191:economics; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay; D008875:Middle Aged; D010149:Postoperative Pain; D017060:Patient Satisfaction; D013997:Time Factors; D014463:Ultrasonography