Clinical assessment for three routes of hysterectomy.
BACKGROUND
Hysterectomy is a very common surgery in gynecology. Ideal surgery for hysterectomy is microinvasive with few complications. There are three major routes of hysterectomy that are currently used. The aim of this study was to identify the differences of peri-operative outcome among the patients who underwent the three different approaches.


METHODS
One hundred and one women undergoing hysterectomy for myoma had the procedure performed by laparoscopic assisted vaginal hysterectomy (LAVH), total vaginal hysterectomy (TVH) or total abdominal hysterectomy (TAH) in a randomized study. We compared the course of peri-operative and post-operative outcome for the three different approaches.


RESULTS
were evaluated by linear regression analysis, Fisher's exact test and Student's t test for independent samples.


RESULTS
The operation time among the three procedures was not significantly different (P > 0.05). The amount of blood loss in the TVH group was less than in the LAVH and TAH groups (P < 0.05). The pain score 3 hours after operation in the LAVH group was significantly lower than in the TAH and TVH groups (P < 0.001). The pain scores in the LAVH and TVH groups were lower than in the TAH group at 24 and 48 hours after operation (P < 0.01). The women who underwent LAVH and TVH had a shorter hospitalization stay (P < 0.001). The highest body temperature after operation in the TAH group was higher than that in LAVH and TVH groups (P < 0.001).


CONCLUSIONS
LAVH and TVH are better procedures for women requiring hysterectomy. The peri-operative and post-operative courses of TVH are better than LAVH, excluding the pain score 3 hours after operation. Vaginal hysterectomy is the most cost-effective approach but the final choice for the route of hysterectomy can depend on many factors such as gynecological disease, patients' health status and experiences of the gynecologist.
Zhu
Lan
L
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. Zhu_Julie@sina.com
Lang
Jing-he
JH
Liu
Chun-yan
CY
Shi
Hong-hui
HH
Sun
Zhi-jing
ZJ
Fan
Rong
R
D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods* / Q000592:standards*; D007045:Hysterectomy, Vaginal / Q000379:methods; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D009214:Myoma / Q000601:surgery*; D010149:Postoperative Pain; D012044:Regression Analysis; D016896:Treatment Outcome