Vaginal or laparoscopic hysterectomy: Do perioperative outcomes differ? A propensity score‐matched analysis

Abstract

Introduction There are assertions that vaginal mode may be the preferred approach of minimally invasive hysterectomy, yet rates of laparoscopic hysterectomy (LH) continue to rise while vaginal hysterectomy (VH) rate remains relatively unchanged. The aim of this study is to compare the perioperative outcomes of LH vs VH. Material and methods We identified women who underwent either LH or VH for benign indications between 2009 and 2015 at a large academic institution. A propensity score‐matched analysis was used to adjust for differences between women undergoing VH vs LH. Outcome parameters were perioperative complications (both intraoperative and postoperative), operative time, blood loss, hospital length of stay, conversion and readmission. Results A total of 1921 patients underwent either LH or VH during the study period. In all, 155 patients from each group were successfully matched using propensity score match analysis. While most intra‐ and postoperative characteristics did not differ between groups, LH was associated with lower blood loss during surgery (102.8 ± 166.5 mL vs 185.0 ± 179.0 mL, P < 0.001) and shorter hospital stay (0.9 ± 1 days vs 1.2 ± 0.9 days, P < 0.0001). Concomitant adnexal surgery was performed more frequently during LH (47.7% vs 12.3%, P < 0.0001), and concomitant prolapse surgery was performed more frequently at the time of VH (14.2% vs 68.4%, P < 0.0001). Conclusions Both VH and LH have overall favorable perioperative outcomes; however, LH is associated with lower blood loss and a shorter hospital stay. The results support the trend toward increasing rates of laparoscopic approach to hysterectomy when appropriate.

National Analysis of Perioperative Morbidity of Vaginal Versus Laparoscopic Hysterectomy at the Time of Uterosacral Ligament Suspension

“…However, neither of these variables was associated with the complication rate in this study population. Previous studies have reported less blood loss with the laparoscopic approach to hysterectomy, and higher rates of concomitant adnexal surgery [16]. Our results strongly support the finding of increased rates of completed adnexal surgery with the laparoscopic route, with an OR >10.…”

Comparison of laparoscopic sacrocolpopexy with vaginal reconstructive procedures and abdominal sacrocolpopexy for the surgical management of vaginal vault prolapse: a systematic review and meta-analysis

“…However, our study showed that was not the case, as blood loss showed lower values in the LSCP group, although this difference did not reach statistical significance. It is plausible that reduced blood loss in case of laparoscopic procedures can be attributed to better visualisation, easier tissue manipulation and access ( 34 , 35 ). Furthermore, the choice of anaesthesia may potentially influence blood loss outcomes.…”

VaNoLaH trial: a study protocol—a multinational randomised controlled trial including two identical substudies comparing vaginal versus vNOTES (vaginal natural orifice transluminal surgery) hysterectomy or laparoscopic versus vNOTES hysterectomy

“…1 The vaginal entrance to the abdomen is considered the most minimally invasive, and despite being associated with the lowest incidence of complications, lowest surgical time and quickest postoperative recovery, the incidence of VH is declining worldwide to the benefit of laparoscopic techniques. [1][2][3] A retrospective cohort study has recently 4 shown benefits of LH over VH, with lower intraoperative bleeding, potentially due to the direct visualisation of the bleeding vessels during laparoscopic surgery.…”