title: Total abdominal hysterectomy versus laparoscopically-assisted vaginal hysterectomy versus total vaginal hysterectomy.
abstract: BACKGROUND
  While total abdominal hysterectomy (TAH) and total vaginal hysterectomy (TVH) are conventional procedures, we have actively introduced laparoscopically-assisted vaginal hysterectomy (LAVH) since its advent. This study was the first attempt to retrospectively compare the surgical results, including invasiveness, among the three methods of performing a hysterectomy.
  
  
  METHODS
  The subjects included 1181 patients who underwent total hysterectomies (TAH, n=465; LAVH, n=629; TVH, n=87) due to uterine fibroids or uterine adenomyosis at our hospital between January 1995 and December 2009. The mean age, parity, weight of the removed uterus, operative time, blood loss, rates of intra- and post-operative complications, length of post-operative hospital stay, leukocyte count, and CRP and hemoglobin levels were compared.
  
  
  RESULTS
  The operative time was significantly longer in the LAVH group than the other two groups. Blood loss was significantly greater in the TAH group than the LAVH and TVA groups. The rates of intra- and post-operative complications were significantly higher in the TAH group than the LAVH group. The CRP level and leukocyte count were significantly lower in the LAVH group than the TAH and TVH groups.
  
  
  CONCLUSIONS
  LAVH can be applied to nulligravidas or patients with relatively large uteri and it is proved less invasive than TAH and TVH in this study. We recommend active application of LAVH.
authors: Department of Obstetrics and Gynecology, Kinki University Faculty of Medicine, Osaka, Japan. shiota@med.kindai.ac.jp
authors: M
authors: M
authors: Shiota
authors: Y
authors: Y
authors: Kotani
authors: M
authors: M
authors: Umemoto
authors: T
authors: T
authors: Tobiume
authors: M
authors: M
authors: Shimaoka
authors: H
authors: H
authors: Hoshiai
mesh_terms: D000328:Adult; D000368:Aged; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007045:Hysterectomy, Vaginal / Q000379:methods; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy; D007889:Leiomyoma / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000601:surgery; D014594:Uterine Neoplasms / Q000601:surgery*