Laparoscopic-assisted vaginal hysterectomy versus minilaparotomy hysterectomy: a prospective, randomized, multicenter study.
OBJECTIVE
The aim of this study was to compare operative and early postoperative outcomes of laparoscopic-assisted vaginal hysterectomy (LAVH) and minilaparotomy in a randomized clinical trial including patients undergoing total hysterectomy for benign gynecologic disease and having 1 or more of the generally considered contraindications to vaginal route.


METHODS
Prospective, randomized, multicenter trial (Canadian Task Force classification I).


METHODS
Departments of Gynecology from 3 major university hospitals in Rome.


METHODS
Eighty-one patients who were candidates for abdominal hysterectomy.


METHODS
Laparoscopic-assisted vaginal hysterectomy and minilaparotomy hysterectomy.


RESULTS
Forty patients were randomized to LAVH and 41 to minilaparotomy. Characteristics of patients and indications for surgery in the 2 arms were comparable. In the minilaparotomy group, complications were as follows: 1 case (2.4%) of delayed laparotomy with 2 units of red blood cell transfusion, 2 cases (4.8%) of wound infection, and 3 cases (7.3%) of fever of unknown origin. No minor or major complications were observed in the LAVH group. Postoperative visual analog scale pain scores at days 1 and 2 were significantly lower in the LAVH group (p <.05). The complication rate between the 2 groups was significantly lower for LAVH (p = .026).


CONCLUSIONS
Because LAVH was associated with significantly lower early postoperative pain scores and complication rates, in general LAVH should be preferred to minilaparotomy hysterectomy when the vaginal approach cannot be used.
Muzii
Ludovico
L
Department of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy. l.muzii@unicampus.it
Basile
Stefano
S
Zupi
Errico
E
Marconi
Daniela
D
Zullo
Marzio Angelo
MA
Manci
Natalina
N
Bellati
Filippo
F
Angioli
Roberto
R
Benedetti Panici
Pierluigi
P
D000328:Adult; D000075202:Contraindications; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000601:surgery