Comparison of total laparoscopic hysterectomy and laparoscopic assisted vaginal hysterectomy – a 2-year retrospective study

Abstract

Background: Hysterectomy is one of the most commonly performed major surgeries. Recently, increasing number of minimally invasive approaches, such as TLH and LAVH has been applied. People undergoing laparoscopic hysterectomy experience shorter hospitalization, a smaller wound, more rapid recovery, and shorter absence from work compared to patients undergoing abdominal hysterectomy. The objective of present study is to compare the surgical short term results between Laparoscopic assisted vaginal hysterectomy (LAVH) and Total laparoscopic hysterectomy (TLH) in our centre in two years.Methods: This was a retrospective study of 93 women who underwent LAVH and 55 women who underwent TLH. The statistical analysis is done by using Students t-test, Chi-square test, and Mann-Whitney test appropriately.Results: There were no differences between the two groups with respect to age, BMI, Indication of surgery, Uterine size, Previous pelvic surgery, average blood loss and hemoglobin change (P=0.4). The duration of surgery was longer in TLH (124 min vs. 76.9 min) and is found to be extremely significant (P=0.0001). There was significant statistical difference in respect to hospital stay (P=0.0076). There was no significant statistical difference in various complication rates (P=0.22).Conclusions: Both TLH and LAVH are safe methods in performing hysterectomy, but LAVH has advantages over TLH with reduced operating time and less hospital stay even for the patients with history of previous pelvic surgery.

Total laparoscopic hysterectomy: why surgeon teachers must learn and train residents

“…Total Laparoscopic hysterectomy has a genuine concern of ureteric injury. 12 In a Gendy metaanalysis comparing VH and TLH, TLH was associated with shorter hospital stay, with no differences in complications, blood loss or urinary tract injury. 13 Sonali Ingole concluded that, TLH is safe and effective procedure for most of the benign pelvic conditions.…”

A new knotless parametrial tissue ligation technique for safe total laparoscopic hysterectomy

“…However, the uterine weights were significantly heavier in the LAVH group than in the TLH group (270.87±145.93 g vs. 189.70±108.98 g, P <0.01); hence, the author concluded that LAVH may be preferred if the uterus is relatively large. A recent retrospective study also suggested that LAVH had the advantage of a shorter operative time compared to TLH (76.9±25 minutes vs. 124±39.7 minutes, P =0.0001) [ 5 ]. In the aforementioned studies, TLH surgery was performed with the use of bipolar coagulation, except at the vaginal cuff closure step.…”

“…In particular, TLH requires more technical skills and has a steeper learning curve than LAVH because TLH requires dissection of the entire uterus, ligation of the uterine vessels, and suturing of the vaginal stump exclusively via a laparoscopic approach [ 5 ]. On the other hand, LAVH, which combines laparoscopic and vaginal access, may be difficult if there are pelvic adhesions from prior pelvic surgeries or if the vagina is narrow [ 5 , 6 ]. Therefore, choosing an appropriate hysterectomy method according to the patient’s characteristics, uterus size, and the surgeon’s experience is important [ 7 ].…”

“…However, advanced skills are needed to perform LH owing to technical difficulties such as crowding of instruments and lack of triangulation [4]. In particular, TLH requires Ju Hee Kim, et al Knotless parametrial ligation for TLH more technical skills and has a steeper learning curve than LAVH because TLH requires dissection of the entire uterus, ligation of the uterine vessels, and suturing of the vaginal stump exclusively via a laparoscopic approach [5]. On the other hand, LAVH, which combines laparoscopic and vaginal access, may be difficult if there are pelvic adhesions from prior pelvic surgeries or if the vagina is narrow [5,6].…”