Laparoscopically-assisted vaginal hysterectomy for enlarged uterus: operative outcomes and the learning curve

Abstract

Objectives: The aim of the study was to compare the effects of uterine size and surgeon experience on the surgical outcomes of laparoscopically-assisted vaginal hysterectomy (LAVH) for benign gynecological conditions. Material and methods:This was a retrospective analysis of 184 LAVH cases. All hysterectomies were performed by the same surgeon and divided into two groups, with uterine weight of < 280 g (group 1) and uterine weight of > 280 g (group 2). The groups were compared in terms of the effects of the uterine size and surgeon experience vs. the operative outcomes (operative time, change in hemoglobin levels, hospital stay, and perioperative complications).Results: No significant differences in mean age, parity, history of chronic systemic diseases and previous surgery history were observed between the two groups. However, operative time was significantly greater in group 2 as compared to group 1 (132.1 ± 42.7 minutes vs. 111.5 ± 30.4 minutes, p < 0.05). There were no differences in the hospital stay and perioperative complications between the two groups. One case of bladder injury occurred in each group and one patient underwent a second laparoscopic surgery for postoperative bleeding in group 2. Greater surgeon experience was demonstrated to be associated with decreased operative bleeding and, consequently, smaller differences between preoperative and postoperative hemoglobin levels. Operative time was also reduced as the surgeon was getting more experienced but the effect did not reach statistical significance. Conclusions:Our study supports the thesis that LAVH is a safe and effective procedure for managing benign gynecological conditions. Despite increased operative time, LAVH can be safely performed for enlarged uterus in conjunction with increased surgeon experience.

Laparoscopic Hysterectomy with Prior Uterine Artery Ligation versus Conventional Laparoscopic Hysterectomy

“…When choosing between Vaginal Hysterectomy (VH), Abdominal Hysterectomy (AH), and Laparoscopic Hysterectomy (LH) methods, it will depend on the surgeon experience, operative indication, size and weight of the uterus, and previous abdominal operations [2] .…”

Vaginal hysterectomy compared to abdominal and laparoscopic hysterectomies in patients without uterine prolapse

“…There are many randomized studies comparing the outcomes of hysterectomy types (18). The decision on the surgical technique to be chosen depends on the training and experience of the surgeon, the indication of the operation, the size and weight of the uterus and the number of past abdominal operations (19). In this study, 35 patients without prolapse who underwent vaginal hysterectomy in our clinic due to benign hysterectomy indication between January 2013 and February 2018 were compared to patients who underwent abdominal and laparoscopic hysterectomies with respect to intraoperative and postoperative complications.…”

Laparoskopik histerektominin klinik sonuçları: tek merkez deneyimi

“…3,4 The choice of hysterectomy method may be affected by the surgeon's experience, the surgical indication, the size and weight of the uterus, or a history of earlier abdominal surgery. [5][6][7] The advantages of LH are a shorter hospital stay, less blood loss, faster recovery, a more rapid return to daily activities, a reduced need for postoperative analgesics, and the avoidance of a large abdominal surgical incision; its disadvantages are a longer intra-operative period and the required learning curve for the surgeon. 5,8,9 Although previous studies have recommended the avoidance of conventional AH in cases where VH is not applicable, many gynecologists still prefer AH.…”

“…[5][6][7] The advantages of LH are a shorter hospital stay, less blood loss, faster recovery, a more rapid return to daily activities, a reduced need for postoperative analgesics, and the avoidance of a large abdominal surgical incision; its disadvantages are a longer intra-operative period and the required learning curve for the surgeon. 5,8,9 Although previous studies have recommended the avoidance of conventional AH in cases where VH is not applicable, many gynecologists still prefer AH. However, LH, in which the intra-pelvic and intraabdominal anatomy are rather well explored may be preferred instead of AH.…”

“…However, LH, in which the intra-pelvic and intraabdominal anatomy are rather well explored may be preferred instead of AH. 3,5,10 In addition, as technology and surgical experience have improved, it has become possible to perform laparoscopic lymphadenectomies concurrently with LH. 8 In the present study, our aim was to evaluate the clinical results of LH performed at our hospital between 2010 and 2016.…”