Laparoscopic assisted vaginal hysterectomy (LAVH) – truly an advance in gynecological surgery

Within the past decade, acceptance of minimally invasive techniques has changed the traditional approach to hysterectomy from open abdominal procedures to laparoscopy 1. Our objective was to compare efficiency of LAVH and TAH (total abdominal hysterectomy). This retrospective case control study was done in the Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehradun, over a period of 18 months from October 2012 to March 2014. Data from medical records of 50 patients who underwent LAVH were reviewed and taken as cases. Out of the total 186 cases that underwent TAH during this period, 50 cases were matched in a case control manner, with the patients for whom LAVH was done and were recruited as controls. Statistical analysis was done using Student-t test and Chi-square test. Mean operative time was 150.83±41.55 minutes for LAVH group, which was significantly longer than 99±14.20 minutes for TAH group (p<0.001). The estimated blood loss in LAVH group was significantly lower than in TAH group (116.08±14.23 and 150.20±24.83, p=0.001). The drug requirement to control pain i.e. number of doses of injectable analgesics (Diclofenac in mg) used per patient was significantly more in TAH group (135.00+_67.50 Vs 300.00+_75.00). Overall complication rate was comparable in both the groups (10% in LAVH group and 14% in TAH group). Patients of LAVH had statistically significant higher activity score and shorter convalescence. Taking all the parameters together, LAVH was marginally costlier than TAH. LAVH safely and efficiently tackles abdomino-pelvic adhesions, endometriosis and complex adenexal masses. Hence enables the surgeon to convert most of the difficult abdominal hysterectomies into vaginal ones with all the benefits of a vaginal procedure. LAVH is patients' favorite because of its smaller incisions, less postoperative pain, shorter hospital stay, rapid return to normal activity and better body image.