The Laparoscopic-Assisted Combined Hysterectomy: A New Surgical Concept Compared to the Classical Laparoscopic-Assisted Vaginal Hysterectomy by a Prospective Study.

BACKGROUND AND AIMS: This controlled trial with II-1 evidence compared the safety and efficacy of the new laparoscopic-assisted combined hysterectomy (LACH) with the standard surgical technique laparoscopic-assisted vaginal hysterectomy (LAVH) in general and in patients displaying risk factors (large uterus, vaginal nulliparity, prior caesarean section).

METHODS: From June 2007 to September 2008, 101 patients underwent a hysterectomy at the Clinic of Gynaecology, Obstetrics and Gynaecological Oncology at the Pius Hospital, University Hospital for Gynaecology in Oldenburg. The main outcome measures were feasibility, postoperative analgesia, postoperative inflammatory reaction, and duration of surgery. Statistical analyses were performed using SPSS for Windows (p < 0.05).

RESULTS: We observed no significant differences between LACH and LAVH regarding outcome parameters or when risk factors were considered. Within the LACH group, the duration of surgery was significantly shorter for patients with UW <400 g. Still within the normal range, caesarean sections from both groups revealed significant differences in the number of leucocytes on the 2nd post-operative day. No urinary tract injuries, no unplanned conversion to laparotomy, no severe perioperative complications occurred in either group.

CONCLUSION: In terms of technical feasibility, LACH represents a safe alternative for abdominal HE when LAVH is contraindicated.