Page 48 - WJOLS - Surgery Journal

World Journal of Laparoscopic Surgery, January-April 2009;2(1):49-52
Laparoscopic Hysterectomy—Beyond Garry and Reich Classification
Laparoscopic Hysterectomy—Beyond Garry

and Reich Classification

Hassan
Consultant Obstetrician and Gynecologist, Nairobi, Kenya

Abstract INTRODUCTION
The advantages and disadvantages of laparoscopic hysterectomy (LH)
and laparoscopic assisted vaginal hysterectomy (LAVH) have been Total laparoscopic and assisted vaginal hysterectomy are
reviewed. Studies show that both procedures are safe and the patients relatively new procedures that are rapidly replacing abdominal
show similar postoperative reconstitution. A number of studies show hysterectomy because of perceived benefits including reduced
that LAVH is faster to perform and therefore amenable to the stated morbidity, early mobilization and recovery and significantly
objective of making these service available on a day care surgery basis. better esthetics. Laparoscopic vaginal hysterectomy has
Other studies show that, with adequate skill laparoscopic hysterectomy enhanced the capacity of gynecological surgeons to deal with
is easier to perform and has less associated morbidity as well as reduced pelvic pathology that were previously a relative contrain-
cost. The varied and divergent views with regard to the efficacy and dication for vaginal hysterectomy. Since vaginal hysterectomy
acceptance of the procedures primarily depend on the practices in
different regions and programs. Acceptance of laparoscopic or has been utilized to perform one third of all hysterectomies,
laparoscopic vaginal hysterectomy varies in different regions. There is this constituted an important development in gynecological
necessity therefore to develop further this procedures which have health.
high level of satisfaction among female patients. The uptake of this Many service providers advocate for laparoscopic assisted
procedure is slow particularly in the Third World Countries there is vaginal hysterectomy (LAVH) because of supposed benefit
need to promote policy and programs within the different regions so over and above those of total laparoscopic hysterectomy (TLH),
that endoscopic surgery becomes part and parcel of curricular in both including increased safety, and ease of operation. There is
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undergraduate and postgraduate programs. Only then would the
problems associated with the learning curve be minimized. less risk to bladder, bowel and vascular injury. The hazard
associated with resection of uterine arteries is avoided. However,
Keywords: Total laparoscopic hysterectomy, laparoscopic assisted
hysterectomy, abdominal hysterectomy, vaginal hysterectomy, pelvic a number of publications indicate resection of the uterine artery
pathology. can be achieved safely during TLH using bipolar diathermy,
ligature and clear set step by step procedures.
Aims and objectives: The aim of this study was to review the safety
and efficacy of total laparoscopic hysterectomy and the laparoscopic In many studies there is no significant difference between
assisted vaginal hysterectomy in women. Garry and Reich classified the benefits accrued in either of the two procedures. Some
modes of hysterectomy into nine types. This study will review relative studies indicate that there is no risk of reduction in the length
efficiency and efficacy of type 3 and type 5 of this classification. The and prolapsed of the vaginal vault in TLH as compared with
parameters used to evaluate literature both in the total laparoscopic laparoscopic assisted vaginal hysterectomy.
hysterectomy and the laparoscopic assisted vaginal hysterectomy
include; patient selection criteria, operative time and technique, intra- Since the first LAVH by Reich in 1989 arguments regard
operative and postoperative complications, time until resumption of cost benefit analysis of this procedures has continued to be
diet, postoperative morbidity, hospital stay, cost effectiveness and generated. It is necessary therefore that a study that avoid
the quality of life. confounding factors and many of the biases in the health
Materials and methods: A literature review was performed using system be carried out.
Highwire press, Google, and the Springer link search engine. The It is the considered opinion of this review, that there is need
following terms were used: Laparoscopic assisted vaginal hysterec- to expand on the Garry and Reich classification and consider
tomy, total laparoscopic hysterectomy, total abdominal hysterectomy, the different laparoscopic approaches, as complimentary matrix
vaginal hysterectomy. Over two hundred and fifty six citations were of procedures, through which one can surf back and forth during
found. Selected papers were screened for further reference. Criteria for
selection of the literature were the number of cases, method of analysis, minimal access hysterectomy depending on the challenges
operative procedure and the institution were the study was done. encountered intraoperatively.
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