Randomized comparison of total laparoscopic, laparoscopically assisted vaginal and vaginal hysterectomies for myomatous uteri

• Published in: Archives of gynecology and obstetrics Vol. 290; no. 3; pp. 485 - 491
• Main Authors: Sesti, Francesco, Cosi, Veronica, Calonzi, Francesca, Ruggeri, Velia, Pietropolli, Adalgisa, Di Francesco, Lucia, Piccione, Emilio
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2014; Springer Nature B.V
• Subjects: Adult; Blood Loss, Surgical - statistics & numerical data; Electric noise; Endocrinology; Female; General Gynecology; Gynecology; Human Genetics; Humans; Hysterectomy; Hysterectomy - methods; Hysterectomy, Vaginal - methods; Intestinal Pseudo-Obstruction - epidemiology; Laparoscopy; Leiomyoma - surgery; Length of Stay - statistics & numerical data; Linear Models; Medicine; Medicine & Public Health; Middle Aged; Obstetrics/Perinatology/Midwifery; Operative Time; Pain, Postoperative - etiology; Patient Discharge; Postoperative Complications; Prospective Studies; Uterine Neoplasms - surgery; Visual Analog Scale; Vaginal hysterectomy; Laparoscopically assisted vaginal hysterectomy; Enlarged myomatous uteri; Total laparoscopic hysterectomy
• ISSN: 0932-0067; 1432-0711
• DOI: 10.1007/s00404-014-3228-2

Purpose
To compare the operative data and early postoperative outcomes of total laparoscopic hysterectomy (TLH), laparoscopically assisted vaginal hysterectomy (LAVH) and vaginal hysterectomy (VH).
Methods
One hundred and eight women requiring hysterectomy for enlarged myomatous uterus were randomly allocated into three treatment arms: TLH (
n
 = 36); LAVH (
n
 = 36); VH (
n
 = 36). Randomization procedure was based on a computer-generated list. The primary outcome was the discharge time comparison. The secondary outcomes were operating time, blood loss, paralytic ileus time, intraoperative complications, postoperative pain, and early postoperative complications.
Results
The mean discharge time was shorter after VH than after LAVH and TLH (
P
 = 0.001). Operating time significantly influenced the discharge time, considered as a dependent variable in general linear model analysis (
P
 = 0.006). In contrast, blood loss did not influence the discharge time (
P
 = 0.55).The mean operating time was significantly shorter in VH than in TLH and LAVH groups (
P
 = 0.000).The intraoperative blood loss was greater during LAVH than during TLH and VH (
P
 = 0.000).Paralytic ileus time was shorter after VH than after TLH and LAVH (
P
 = 0.000). No intraoperative complications or conversion to laparotomy occurred.
Conclusions
VH was the faster operative technique with smaller blood loss and shorter discharge time compared with the others two techniques. So, VH should be considered the preferred approach in patients with enlarged myomatous uteri. When VH is not feasible or salpingo-oophorectomy is required, LAVH or TLH should be considered as valid alternatives. It is necessary to continue prospective comparative studies between the various surgical options to identify the best approach for hysterectomy in each single woman.