Laparoscopic assisted vaginal hysterectomy versus abdominal hysterectomy - Reply

Dr Al-Jubouri's assumption, that laparoscopic assisted vaginal hysterectomy (LAVH) already has a clinically proven reputation for being minimally invasive with less morbidity, is scientifically unfounded. Despite the shorter hospital stay, the laparoscopic procedure takes, on average, 35min and 70min longer in operation time than abdominal and vaginal hysterectomy, respectively, and is associated with more intra-operative complications (6%) compared to either abdominal (4%) or vaginal hysterectomy (2%).(1) A prospective, randomized trial found no differences between LAVH and the traditional vaginal approach with regard to estimated blood loss and operative and postoperative complications, postoperative hospital stays and periods of convalescence.(2) Another recent study showed that complications related to haemorrhage or the accidental laceration of blood vessels, nerves or organs were most common with the laparoscopic procedure.(3) In fact, laparoscopic assisted vaginal hysterectomy has generated more controversy than any other laparoscopic procedure and, based on current knowledge, its benefits remain uncertain.(4,5) Dr Al-Jubouri's suggestion that a comparison of the postoperative inflammatory response to a single surgical procedure performed by various surgeons might be more fruitful to future patients, as they may wish to choose their surgeon, is somewhat naive. First, patients are generally referred to specialists for a clinical opinion and not for a specific procedure. Secondly, the choice of which procedure to use can only be made by the surgeon to whom the patient has been referred, and is based on clinical criteria. Moreover, 12% of LAVH procedures are converted to open laparotomy during operation.(1) Concerning Dr Al-Jubouri's final statement, we believe that researchers and scientists in particular should not rely simply on their common sense, but on objective and scientific evidence.(6) Based on current knowledge, the overall benefits of laparoscopic assisted vaginal hysterectomy remain uncertain and we believe that our findings provide, for the first time, some objective and scientific evidence that may help in resolving the controversy surrounding this procedure.