Laparoscopic assisted vaginal hysterectomy (LAVH)-An effective alternative to conventional abdominal hysterectomy

Objectives: To compare LAVH with TAH in terms of indications, operable uterine size, operative time, intraoperative blood loss, complications, postoperative pain and hospital stay, convalescence and average total cost; also to evaluate LAVH for its feasibility in patients with previous abdominal surgery and those requiring other surgical procedures. Material and Methods:Aretrospective study was conducted on 550 patients (350 patients of LAVH, 200 patients of TAH) who underwent surgery at Fortis Escorts Hospital, Faridabad, between January 2005 and May 2007. Statistical analysis was done using Student-t test and Chi-square test. Results: On comparing LAVH with TAH, the mean operative time was 63 vs 55 min (p<0.001), blood loss 116 vs 150ml (p<0.001), major complication rate 2% vs 5% hospital stay 2.7 vs 5.7 days (p<0.001). Patients of LAVH had statistically significant lower pain scores, higher activity scores, shorter convalescence and quicker resumption of normal activity. LAVH was marginally costlier than TAH. Conclusion: LAVH enables the surgeon to convert most of the difficult abdominal hysterectomies into vaginal ones with all the benefits of a vaginal procedure. It is also a feasible and safe procedure in patients with previous abdominal surgery, large uteri and adnexal masses. LAVH enjoys patient's support with lesser postoperative pain, shorter hospital stay, rapid return to normal activity and better body image.