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Sheriff Z Kotb et al
          both groups but more in the second group. Operative     6.  Ben Hur H, Phipps JH. Laparoscopic hysterectomy. J Am
          blood loss was higher in the LAVH group. Two cases      Assoc Gynecol Laparosc 2000 Feb;7(1):140-146.
          in the LAVH group were converted to laparotomy to     7.  Reich H, Roberts L. Laparoscopic hysterectomy in current
                                                                  gynecological practice. Gynaec Pract 2003 Jun;3(1):32-40.
          control bleeding and to repair a urinary bladder tear. The     8.  Munver, R, Del Pizzo, JJ, Sosa, RE. The evolution and current
          HALH group showed less analgesic consumption, earlier   applications of hand assisted laparoscopy. Contemporary
          ambulation, shorter hospital stay, and earlier regain of   Urology, 2003;15(10):30-58.
          daily and coital activities. On the contrary, the HALH     9.  Meijer DW, Bannernberg JJ, Jakimowicz JJ. Hand – assisted
          group had much more direct costs.                       endosc 2000;14:891-895.
                                                                10.  Ikram M, Saeed M, Shazia J. Hysterectomy comparison
          KEY MESSAGES                                            of laparoscopic assisted vaginal versus total abdominal
                                                                  hysterectomy. Professional Med J 2012 Mar-Apr;19(2):
          Hand-assisted laparoscopic technique was successfully   214-221.
          developed and manual access to the laparoscopic field     11.  Park J-Y, Kim D-Y, Kim J-H, Kim YM, Kim YT, Nam JH.
          facilitated completion of an otherwise minimally invasive   Laparoscopic versus open radical hysterectomy for elderly
                                                                  patients with early-stage cervical cancer. Am J Obstet Gynecol
          procedure.                                              2012 Sep;207(3):195.e1-195.e8.
             We demonstrated that HALH is technically feasible,     12.  Hong JH, Choi JS, Lee JH, Eom JM, Ko JH, Bae JW, Park SH.
          and in selected cases may provide an alternative to     Can laparoscopic radical hysterectomy be a standard surgical
          conventional techniques of hysterectomy.                modality in stage IA2–IIA cervical cancer? Gynec Oncol 2012
             Modifications in the technique that reduce surgical   Oct;127(1):102-106.
          time would be beneficial and careful case selection and     13.  Ding DC, Chu TY, Chan YH.  Trend changes in the proportion
                                                                  of minimal invasive hysterectomies over a five-year period:
          preparation is important for a successful outcome.      a single-center experience. Tzu Chi Med J 2012 Sep;24(3):
             In our study the direct cost of HALH was much        136-138.
          more than laparoscopic hysterectomy, because the LAP     14.  Twijnstra ARH,  Kianmanesh  Rad NA,  Smeets MJGH,
               ®
          DISC  alone costs about £850. So we recommend its       Admiraal JF, Jansen FW. Twenty-first century laparoscopic
          usage in patients with large uteri as the indirect costs of   hysterectomy: Should we not leave the vaginal step out?
                                                                  Gynecol Surg 2009 Nov;6(4):311-316.
          conventional laparotomy may exceed the direct costs of     15.  Shin  JW,  Lee  HH,  Lee  SP,  Park  CY.  Total  laparoscopic
          hand-assisted surgery.                                  hysterectomy and laparoscopy-assisted vaginal hysterectomy.
                                                                  JSLS 2011 Apr-Jun;15(2):218-221.
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