Assessing the role of laparoscopically assisted vaginal hysterectomy in the everyday practice of gynecology

OBJECTIVE: To assess how often a gynecologist may have to apply a laparoscopic technique over a traditional vaginal approach to avert total abdominal hysterectomy. STUDY DESIGN: This retrospective study involved 349 consecutive hysterectomies performed by the author in his private practice from January 1990 to December 1993. A vaginal route was selected for every patient except those who had universally accepted indications for laparotmoy or who posed predictable technical difficulties. RESULTS: A total or 306 patients (87.7%) underwent vaginal hysterectomies without a single conversion to total abdominal hysterectomy. Excluding those with malignant disease, 304 women (91.3%) underwent vaginal hysterectomies. Five patients (1.4%) who had total abdominal hysterectomies could have been converted to a vaginal route with the visual assistance of a laparoscope. Mean operation time was 64 minutes without oophorectomy and 71 minutes with it. Mean length of stay was 1.9 days after vaginal hysterectomy, 1.8 without oophorectomy and 2.1 with it. CONCLUSION: The proportion of vaginal hysterectomies in the total number of hysterectomies should be >80%, perhaps closer to 90%, instead of the current 25-30%. Laparoscopy may assist in converting a potential total abdominal hysterectomy case to a vaginal route in very limited cases, probably in the range of 2-3%.