Laparoscopic Assisted Vaginal Hysterectomy versus Vaginal Hysterectomy

Hysterectomy is one of the commonest gynecological operations. The outcomes following vaginal hysterectomy have been proved to be better than those following abdominal hysterectomy. Since the availability and widespread use of laparoscopic hysterectomy, the mode of hysterectomy is an issue of debate in cases of non prolapsed uteri, amongst proponents of vaginal and laparoscopic surgery. Laparoscopic surgeons propose that with the aid of laparoscope, a potential abdominal hysterectomy can be converted to a vaginal one and a difficult vaginal hysterectomy can be converted into a fairly simple vaginal hysterectomy. Laparoscopy can facilitate surgery vaginally in cases of suspected adnexal disease, endometriosis, narrow vagina and in cases where uterine size is greater than 12 weeks gestation. Many gynecologists however routinely perform salpingo ophorectomy and vaginal hysterectomy for nulliparous uteri. Vaginal hysterectomy is the route of choice for benign uterine disease. Size of uterus, previous pelvic surgery, mild endometriosis, uterine fibroids, and history of pelvic infections should not be considered as absolute contraindications for vaginal surgery. There are few trials comparing the outcomes of laparoscopic assisted vaginal hysterectomy versus vaginal hysterectomy .This article compares these outcomes and presents difference in outcomes in terms of operating time, estimated blood loss, analgesia and post-operative pain relief, recovery milestones, hospital stay and cost effectiveness, complication rates and patient satisfaction. Laparoscopic approach has definite advantages in cases of severe endometriosis, selected patients with a suspicion of coexisting pathology and post operatively to rule out hemorrhage.