Experience with laparoscopic assistance in vaginal hysterectomy.

ABSTRACT

OBJECTIVE: To determine safety and usefulness of laparoscopy intended to convert an abdominal into a vaginal hysterectomy. STUDY DESIGN: Forty-seven consecutive hysterectomies are retrospectively analyzed in which laparoscopy was used to accomplish a vaginal instead of an abdominal procedure which would have been performed without endoscopic surgery. RESULTS: In four patients the operation had to be converted to laparotomy due to difficult access (n = 3) or heavy bleeding (n = 1). Operation time declined during the study period, thus highlighting the importance of experience with laparoscopic technics. Major complications such as injuries of adjacent organs or delayed haemorrhage requiring a second intervention were not encountered. CONCLUSIONS: Laparoscopy in hysterectomy seems to be a valuable method to avoid laparotomy. In the future, guidelines to determine the route of surgery are to be established which include those conditions in which laparoscopy in addition to vaginal hysterectomy implies a benefit for the patient.