A randomised comparison and economic evaluation of laparoscopic‐assisted hysterectomy and abdominal hysterectomy

Abstract

Objectives To determine the safety, cost effectiveness and effect on quality of life of laparoscopicassisted vaginal hysterectomy (LAVH) compared with total abdominal hysterectomy (TAH) in the management of benign gynaecological disease.Design Randomised controlled trial and economic evaluation.Setting Three hospitals in the West of Scotland.Participants Two hundred women scheduled for an abdominal hysterectomy for benign gynaecological disease.Main outcome measures Conversion rate of LAVH to TAH, complication rates, NHS resource use and costs, quality of life using EuroQol5 D visual analogue scale, and achievement of milestones.Results The overall incidence of operative complications was 14% in the TAH group and 8% in the LAVH group, with an 8% conversion rate. Length of operation was significantly greater in the women having LAVH at 81 +30 min vs 47 +16 min (P < 0.001). There was no difference in analgesic requirements between the groups although there was a significantly shorter hospital stay for those having LAVH. The rate of post-surgery recovery, satisfaction with operation and quality of life at four weeks post-operative were similar in the two groups of women. LAVH was significantly more expensive than TAH and remained more expensive for all but the most extreme scenario. ConclusionsThis study demonstrates that despite the decreased length of hospital stay, LAVH is more expensive than TAH. In addition, recovery following operation and patient satisfaction were not affccted by the route chosen. It is unlikely that LAVH represents an efficient use of NHS resources.

Treatment options for dysfunctional uterine bleeding: evaluation of clinical results

“…TCRE or ablation is an effective and possibly cheaper alternative to hysterectomy with faster recovery although re-treatment is sometimes needed [75]. The CREST study on the complication rate for minor and major operations, reports a 25% complication rate for vaginal hysterectomy and a 43% for abdominal hysterectomy [76]. The VALUE study confirmed that more than 10% of women treated by hysterectomy for DUB reported immediate or long-term complications [77].…”

Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery

“…At the end of follow-up, 12 weeks after surgery, there were no significant differences between the two patient groups. Lumsden et al [74] used the Euroqol Health Questionnaire (Euroqol HQ [34]) for 166 hysterectomy patients (1b). The groups were compared 1, 6, and 12 months after surgery, but there were no significant differences in QoL.…”

Laparoscopic hysterectomy and ureteric injury: a comparison of the initial 275 cases and the last 1,000 cases using staples

“…In the trial by Lumsden et al [23], 76 of the 95 patients in the LH arm had the "uterine arteries divided using the Endo GIA disposable stapling device" and yet the Review [20] classified the LHs in this trial as "non-categorisable". The Review [20] makes important errors with regard to ureteric injuries in this trial by quoting two ureteric injuries in the LH arm and one in the AH arm (see Fig.…”

“…The recent Cochrane Review [20] on the different surgical approaches to hysterectomy for benign gynaecological diseases compares ureteric injuries from LH and AH, with the Review citing four published trials [21][22][23][24][25].…”