Vaginal Hysterectomy VersusLaparoscpoically Assisted Vaginal Hysterectomy for Large Uteri (A Pilot Randomized Clinical Trial)

Abstract

Vaginal hysterectomy has gained great popularity over abdominal hysterectomy over the past decades. This is attributed to the fact that it’s associated with less operative time, less estimated intraoperative blood loss, less incidence of intraoperative complications and shorter period of hospital stay. Large uterine size, previous uterine surgery and lack of uterine descent have been considered obstacles to the vaginal route but the biggest obstacle is the inexperience and the lack of training. A lot of techniques have been adopted to overcome the problem of the large size such as coring, bisection and vaginal myomectomy. Laparoscopic hysterectomy and laparoscopic assisted vaginal hysterectomy are considered to be the beginning of a new era in the history of hysterectomy, LAVH is now accepted as an attractive alternative to abdominal hysterectomy in nearly all benign pathologies. It’s associated with less operative complications, less intraoperative blood loss, shorter hospital stay. However, it may be associated with more operative time and higher incidence of urinary complications.

The aim of the current study is to compare between VH and LAVH in cases of uteri weighing more than 280gm as regards the operative and the postoperative outcomes. The current trial was conducted at Ain Shams University Maternity Hospital during the period from 2014 to 2016. A total of 50 cases with uteri larger than 280gm were recruited from the outpatient clinic and included in the study.Then, they were randomized into two groups, group 1 had VH while group 2 had LAVH. The operative time was assessed and the time of any concomitant procedure was excluded, estimated intraoperative blood loss was measured. Moreover, any intraoperative complication was recorded. Postoperatively, any morbidity was recorded as well as the pain score and the length of hospital stay. The total hospital costs was calculated before discharge. Both groups were matched in the demographic data and the history of previous cesarean sections in order to eliminate any factor which can affect the operative time and blood loss. When the two groups was compared, there was no significant difference between the two groups regarding the operative time ,estimated intraoperative blood loss and rate of intraoperative complications. Postoperatively, there was