Laparoscopic vs. abdominal vs. vaginal hysterectomy

Objectives To compare vaginal, total abdominal and laparoscopically assisted vaginal hysterectomy (VH, TAH and LAVH) in terms of morbidity, operating time, blood loss, cost, hospital stay and recovery, and to compare the number of hysterectomies performed using each approach over a period of 3 years. Design Retrospective and prospective study. Setting Moolchand RR. Hospital (Gynaecological Endoscopic Center), New Delhi, India. Subjects A total of 663 patients underwent hysterectomies for different indications. Interventions Patients were assigned to either TAH (n=312), LAVH (n=174) or VH (n=177), with or without salpingo-oophorectomy. Main outcome measures These included estimated blood loss, operating time, complications, hospital stay, time to return to normal work, and cost. Results The estimated blood loss was significantly different with that for TAH being greater than that for LAVH or VH. The operating time for LAVH was longer than that for TAH which in turn was longer than that for VH. Complication rates (major and minor) were 31.34, 13.72 and 12.36% in TAH, LAVH and VH, respectively. The length of hospital stay was found to be least with LAVH and greatest for TAH (P=0.001). The total costs for all three types of hysterectomy were not significantly different (P>0.05). Women in the LAVH and VH groups recovered sooner (16.4 +/- 3.4 and 18 +/- 4.2 days, respectively) than those in the TAH group (30.8 +/- 7.2 days; P=0.001). Conclusions VH is by far the most acceptable procedure in terms of lower complication rates, cost and recovery. LAVH has similar advantages, but is not a substitute for VH. However, it is strongly indicated where VH is not possible. TAH is associated with the highest patient morbidity and the longest convalescence period. Costs are similar in all three procedures.