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WJOLS

Laparoscopic-assisted Vaginal Hysterectomy vs Hand-assisted Laparoscopic Hysterectomy
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Table 11: Technical difference between LAVH and HALH We depended on the findings of Shiota et al when
Items Group 1: LAVH Group 2: HALH we were planning for our study, so we chose 12 cm as a
Incisions. Only small stab A 7 cm incision cutting point for the size of the uterus or adnexa to be
incisions for ports beside the excluded from the study. In the future we are planning
ordinary ports
Incisional hernia 0 0 to study laparoscopic hysterectomy on larger uteri.
Working space More working space The hand inside The reason for converting laparoscopic hysterectomy to
the abdomen the conventional abdominal approach was uncontrollable
encroaches on bleeding or bladder injury. As reported in other studies,
the working space BMI and uterus weight are confirmed to be independent
Device-dependent Rare Occurs more 19
air leakage risk factors for conversion.
Specimen retrieval Difficult Easier Hospital stay in the HALH group was shorter (3.45
Control of bleeding Slower Rapid days) than in the LAVH group (4.57 days). This difference
Depth perception Absent Present was statistically significant (p = 0.007). Duration of
Conversion to open 2 0 hospital stay in our study is comparable to that of Ding
approach et al (5 days), Soliman et al (4.5 days) and Shin et al
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Operative time Longer Shorter (3.79 days). Asian, especially Korean, studies reported
Cost Less Higher 12
LAVH: Laparoscopic-assisted vaginal hysterectomy; HALH: longer durations of hospital stay: Hong et al (7 days)
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Hand-assisted laparoscopic hysterectomy and Park et al (10 days).
We also found no statistically significant difference
between both groups as regards resumption of ordinary
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(270 min); Ding et al (120 min); Twijnstra et al (144 daily activities (mean time is 24 days). But the mean
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min); Shin et al (112.5 min); and Song et al (102 min). duration of resumption of coital activities (if there were)
Estimated blood loss, the need for blood transfusion, was significantly lower in the HALH group (47.67 days)
and haemoglobin reduction were higher in the LAVH compared with the LAVH group (58.00 days). Yi et al,
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group, but the difference is not statistically significant. in a meta-analysis, found this period to vary between 21
Mean estimated blood loss in the LAVH group was 532.62 and 30 days (mean is 25 days).
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mL, which is higher than other studies: Ikram et al For all malignant cases in the study, there were no
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(105.13 mL); Park et al (433.6 mL); Hong et al (500 mL); residual or recurrent tumors. The relatively small number
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Ding et al (200 mL); Twijnstra et al (457 mL); Soliman and the short interval of follow-up make this study
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et al (517.5 mL); and Song et al (314 mL). inappropriate to discuss the effect of various laparoscopic
In our study, there was no relationship between approaches on the oncologic aspects.
the uterine size and the operative time or the rate of
complications. But our study cannot efficiently address
this issue because our patient group was selected with SUMMARY AND CONCLUSION
avoidance of relatively large uteri. In our institution, Laparoscopic-assisted vaginal hysterectomy has become
we are not familiar with morcellation because most of a popular alternative to abdominal hysterectomy in cases
our patients have malignant or potentially malignant that are difficult to manage via vaginal route alone.
conditions. Hand-assisted laparoscopic surgery was first des-
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Shiota et al compared the surgical results (blood loss, cribed in the early 1990s as a surgical method designed
operative time, rates of conversion to laparotomy, intra- to facilitate the performance of challenging laparoscopic
and postoperative complications) among nine groups procedures while maintaining the advantages of a mini-
classified by uterine weight. Statistically significant mally invasive approach.
differences in surgical outcomes were found between Our present study aims to compare between LAVH
the group with a uterine weight ≥800 gm and the other and laparoscopic HALH. We included 41 sequential
groups. So when the uterine weight was ≥800 gm, total patients scheduled for hysterectomy at OCMU from
abdominal hysterectomy was more appropriate because August 2010 to March 2013. They were divided randomly
significant blood loss and/or complications would be (patient by patient) into two groups.
expected during LAVH. A removed uterus weighing The clinical characteristics of the 41 patients were
800 gm is reportedly equivalent to a preoperative uterine similar as regards follow-up duration, age, parity, and
size of approximately 12 cm. Therefore, LAVH may be uterine size. The indications for hysterectomy among
safely indicated for patients with a uterine size ≤12 cm the study groups were nearly similar. No statistically
(approximately equivalent to the uterine size at 16 weeks’ significant difference was found between the two groups
gestation). 18 in operative time, which decreased progressively for
World Journal of Laparoscopic Surgery, May-August 2016;9(2):63-70 69