Laparoscopically assisted vaginal hysterectomy versus vaginal hysterectomy for enlarged uterus

Objectives: To compare the surgical and immediate post-operative outcomes for varginal hysterectomy (VH) with those for laparoscopically assisted vaginal hysterectomy (LAVH) in patients with enlarged myomatous uterus. Methods: Eight women requiring hysterectomy for an enlarged myomatous uterus were randomly allocated into 2 treatment arms: VH (n=40) and LAVH (n=40). The randomization procedure was based on a computer-generated list. The primary outcome was a comparison of the discharge times between the 2 procedures. Continuous outcome variables were analyzed using the Student t test. Discrete variables were analyzed with the chi-square test of Fisher's exact test. P<0.05 was considered statistically significant. Results: The mean discharge time was longer for LAVH than for VH (72+/-4.2 vs 48 +/- 2.6 h; P=0.00). VH resulted in shorter times for paralytic ileus (19+/-3 vs 26+/-3 h; P=0.00) and surgery (71+/-3 vs 129 +/- 7 min; P=0.00). The intraoperative blood loss was less with VH (186.0+/-52 vs 362.7+/-65 mL; P=0.00). No intraoperative complications occured, and no patient was returned to the operative theater in either group. Conclusions: Several surgical and immediate postoperative outcomes were significantly better in the VH group than in the LAVH group. However, further controlled prospective studies are required for identifying the best approach for hysterectomy in patients with enlarged uterus.