Laparoscopic-assisted vaginal hysterectomy with and without laparoscopic transsection of the uterine artery: an analysis of 1,255 cases.

Introduction: To evaluate the operative outcomes of patients managed by laparoscopic-assisted vaginal hysterectomy (LAVH) with and without laparoscopic transsection of the uterine artery for benign gynaecologic diseases.

Patients And Methods: A retrospective analysis of 1,255 women from two different centers undergoing hysterectomy between 1998 and 2009 with benign indications is presented. 856 patients were treated by LAVH type I (vaginal transsection of the uterine artery) and 399 patients by LAVH type II (laparoscopic transsection of the uterine artery). Operative outcomes, intraoperative and postoperative complications, as well as laparoconversion rates were the main objectives of the study.

Results: Median operative time was similar between LAVH type I and II (136 vs. 126 min, respectively, P = NS). Intraoperative complication rate was not significantly different between the two groups of the study (LAVH type I: 1.5% vs. LAVH type II: 1.26%, respectively, P = NS). The injury of the urinary tract, especially of the bladder, was the most common intraoperative complication for both the groups of the study. Laparoconversion rate was similar in LAVH type I and II (0.5 vs. 0.35%, respectively, P = NS), while postoperative complications were significantly higher in LAVH type I (2.25%) compared to LAVH type II (1.16%), mainly because of postoperative vaginal and intrabdominal haemorrhage in the group of the LAVH type I.

Conclusion: LAVH with laparoscopic transsection of the uterine artery is an effective and safe technique with less postoperative complication compared to LAVH with vaginal transsection of the uterine vessels.