Page 15 - World Journal of Laparoscopic Surgery

WJOL S
WJOLS

10.5005/jp-journals-10033-1274
Laparoscopic-assisted Vaginal Hysterectomy vs Hand-assisted Laparoscopic Hysterectomy
RESEARCH ARTICLE

Laparoscopic-assisted Vaginal Hysterectomy vs Hand-

assisted Laparoscopic Hysterectomy

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1 Sheriff Z Kotb, Mohamed El-Metwally, Nazem Shams, Ashraf Khater
ABSTRACT programs to surgeons to increase their experience in enriching
hand skills in this emerging technique.
Objectives and background: The use of laparoscopic
techniques now permits combination of benefits of both Keywords: Hand-assisted laparoscopy surgery (HALS),
abdominal and vaginal hysterectomy. But, laparoscopic Hysterectomy, Laparoscopic-assisted vaginal hysterectomy.
hysterectomy has been associated with a higher risk of urinary How to cite this article: Kotb SZ, El-Metwally M, Shams N,
tract injury compared with abdominal and vaginal procedures, Khater A. Laparoscopic-assisted Vaginal Hysterectomy vs
and the risks of these minimally invasive approaches must Hand-assisted Laparoscopic Hysterectomy. World J Lap Surg
be balanced with the benefits. Hand-assisted laparoscopic 2016;9(2):63-70.
surgery was first described in the early 1990s as a surgical
method designed to facilitate the performance of challenging Source of support: Nil
laparoscopic procedures while maintaining the advantages of Conflict of interest: None
a minimally invasive approach.
Our present study aims to compare between laparoscopic-
assisted vaginal hysterectomy (LAVH) and hand-assisted INTRODUCTION
laparoscopic hysterectomy (HALH).
Hysterectomy is one of the most commonly performed
Materials and methods: This study was conducted at the major gynecological procedures. Approximately 494,000
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Oncology Center of Mansoura University (OCMU). A total of 41
sequential patients scheduled for hysterectomy were divided hysterectomies are performed annually in the United
randomly (patient by patient) into two groups: group 1 included 21 States, making this procedure one of the most commonly
patients who underwent LAVH and group 2 included 20 patients performed surgeries in women of reproductive age. 2
who underwent HALH from August 2010 to March 2013. The optimum approach to hysterectomy would retain
Patients were excluded from this study if they had contraindi- the advantage of abdominal route which includes clear
cations to either vaginal hysterectomy, such as several prior visualization and easy manipulation of the adnexal
abdominal surgeries, vaginal stenosis, or severe endometriosis, structures, and advantage of vaginal hysterectomy,
or to laparoscopy, including underlying medical conditions that namely avoidance of a large abdominal incision. The use
could be worsened by pneumoperitoneum or the Trendelenburg of laparoscopic techniques now permits combination of
position. Body mass index was not a limiting factor for patient
inclusion in the study. these benefits. But, laparoscopic hysterectomy has been
associated with a higher risk of urinary tract injury
Results: The clinical characteristics of the 41 patients were compared with abdominal and vaginal procedures, and
similar as regards age, parity, and uterine size. The indications
for hysterectomy among the study groups were nearly similar. the risks of these minimally invasive approaches must
No statistically significant difference was found between be balanced with the benefits. 3
the two groups in operative time. Operative blood loss was The laparoscopic approach requires a higher level
higher in the LAVH group. Two cases in the LAVH group were of technical skills, especially with total laparoscopic
converted to laparotomy to control bleeding and to repair a hysterectomy (TLH) for which the entire procedure,
urinary bladder tear.
including suturing of the vaginal cuff, is performed by
Conclusion: The HALH group had less analgesic consumption, laparoscopic route. 4
earlier ambulation, shorter hospital stay, and earlier regain of Currently, there are several methods of laparosco-
daily and coital activities. On the contrary, the HALH group
had much more direct costs, which requires much effort to pic hysterectomy including laparoscopic-assisted
be directed toward this fruitful technique and more training vaginal hysterectomy (LAVH), hand-assisted laparosco-
pic hysterectomy (HALH), TLH, and, more recently,
robotic hysterectomy. Three main types of hysterectomy
1-3 Professor, Assistant Professor are now used: Abdominal, vaginal, and laparoscopic.
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1-4 Department of Surgical Oncology, Mansoura Oncology Laparoscopic assisted vaginal hysterectomy has already
Center, Faculty of Medicine, Mansoura University, Dakahlia gained widespread acceptance since it was first reported
Egypt by Reich et al in 1989. 5
Corresponding Author: Sherif Zaki Kotb, Professor Laparoscopic-assisted vaginal hysterectomy has
Department of Surgical Oncology, Mansoura Oncology Center become a popular alternative to abdominal hysterec-
Faculty of Medicine, Mansoura University, Dakahlia, Egypt tomy in cases that are difficult to manage via the vaginal
Phone: 0201005133536, e-mail: drsherifkotb60@yahoo.com
route alone. 6
World Journal of Laparoscopic Surgery, May-August 2016;9(2):63-70 63