Choosing the Route of Hysterectomy

Abstract

Vaginal hysterectomy is the gold standard in the era of minimal access surgery. Some of the contraindications to VH can be overcome by assistance of laparoscope and a potential abdominal hysterectomy can be converted to a vaginal procedure.

The route of hysterectomy: a comparative study between abdominal hysterectomy (AH), non descent vaginal hysterectomy (NDVH), and laparoscopic assisted vaginal hysterectomy (LAVH)

“…In a study by Sandhyasri P et al the mean duration of hospital stay in AH, VH and LAVH group was 8days, 5.08 days and 4.78 days respectively. 7 Similarly, in a study Radhika Y et al it was found that the hospital stay was least with laparoscopic group (4days) as compared to abdominal (9.8days) and vaginal group (5.2days). 9 Thus, the mean hospital stay is much longer in the AH group compared to other two groups.…”

“…In a study by Sandhyasri P et al, 6 cases of wound sepsis and 2 cases of vault hematoma were seen in AH group whereas no cases of wound sepsis or vault hematoma were seen in NDVH and LAVH group. 7 Moradan S et al reported 6 cases of urinary tract infection, 3 cases bladder injury, 2 wound infection, and 16 cases had post-operative febrile morbidity in AH group. One case of urinary tract infection was seen in VH.…”

“…In a study conducted by Sandhyasri P et al the mean age for AH was 40.84 years, NDVH was 41.44 years and that in the LAVH group was 44.57 years. 7 Montefire ED et al conducted an observational prospective study from June to December 2004, the mean parity in their study was 2±1. Thus, the demographic characteristics i.e.…”

“…The p value was <0.05 which was significant. 7 Radhika Y et al conducted an observational prospective study in which included the operating time for LAVH was 128.6 min, NDVH was 88.2 min and AH was 65.38 min. The operating time was shortest for TAH and longest by LAVH group.…”

A clinico-surgical outcome of vaginal hysterectomy with or without hydro dissection: a Quasi experimental study

“…Some of the contraindications to VH can be overcome by assistance of laparoscope and a potential abdominal hysterectomy can be converted to a vaginal procedure. 3 Despite well-documented benefits of vaginal hysterectomy in terms of lower complication rates, shorter hospital stay and convalescence, and better quality of life, therefore, vaginal hysterectomy is preferred when either vaginal or abdominal route is clinically appropriate, the only formal guideline available is the uterine size guide line by ACOG which suggests that the vaginal route is the most appropriate in women with mobile uteri not larger than 12 weeks gestational age (approximately 280 grams). 4,5 ACOG also acknowledges that the choice of approach should be based on anatomical condition, informed patient preference, and the surgeon's expertise and training.…”