A comparison of vaginal, laparoscopic-assisted vaginal, and minilaparotomy hysterectomies for enlarged myomatous uteri

• Published in: International journal of gynecology and obstetrics 2008-12, Vol.103 (3), p.227-231
• Main Authors: Sesti, Francesco, Calonzi, Francesca, Ruggeri, Velia, Pietropolli, Adalgisa, Piccione, Emilio
• Format: Article
• Language: English
• Subjects: Analysis of Variance; Biological and medical sciences; Digestive system. Abdomen; Endoscopy; Enlarged uterus; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Hysterectomy, Vaginal - methods; Investigative techniques, diagnostic techniques (general aspects); Laparoscopic-assisted vaginal hysterectomy; Laparoscopy - methods; Laparotomy; Length of Stay; Medical sciences; Middle Aged; Minilaparotomy hysterectomy; Myoma - surgery; Obstetrics and Gynecology; Postoperative Complications; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; Tumors; Uterine myomas; Uterine Neoplasms - surgery; Vagina - surgery; Vaginal hysterectomy
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1016/j.ijgo.2008.07.006

Abstract Objective To compare the operative data and early postoperative outcome of vaginal hysterectomy (VH), laparoscopic-assisted vaginal hysterectomy (LAVH), and minilaparotomy hysterectomy (MiniLPT). Methods A total of 150 women who required hysterectomy for enlarged myomatous uteri were randomly allocated into 3 treatment groups: VH (n = 50), LAVH (n = 50), and MiniLPT (n = 50). The primary outcome was hospital discharge time. The secondary outcomes were operative time, blood loss, paralytic ileus, postoperative pain, and intraoperative and early postoperative complications. Results Mean hospital discharge time was longest with MiniLPT, and shortest with VH ( P < 0.01). VH was the fastest operating technique, was associated with less blood loss, and resulted in shortest duration of paralytic ileus ( P < 0.01). No intraoperative complications occurred. Conclusion VH should be the preferred surgical approach in patients with enlarged myomatous uteri. When VH is not feasible, LAVH should be considered an alternative to MiniLPT. Further controlled prospective studies are required to confirm these results.