LAVH today...

[Idiopathic]

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...what a nightmare. I am not convinced of the advantages of this procedure over open laparotomy. The operation took almost 6 hours, was relatively without intraoperative complication, but will cost quite a bit more money, the patient still has a sown-together hole where her cervix used to be as well as three cigar-sized holes in the abdomen...anyone have a good article weighing the morbidity advantages of LAVH over open hysterectomy? All I can find are cost studies.

 

[minime]

Idiopathic,

I don't have any of the studies, but from assisting on 30 or more LAVH's and 20 or so TAH's and following all of them post-op I must say that either the case you were involved with was complicated or the surgeon is terrible.

The obgyn group I rotated with did about 7-8 LAVH's per week. They do most of their LAVH's in an outpatient surgery center and they take 45 minutes to 1 hour. The patient stays 23 hours and then he sends them home-most feel really good when they leave.

On the other hand, the TAH's usually stayed inpatient 3,4, sometimes 5 days, depending on when their ileus resolved, etc. They require a lot more narcotics and just require a lot more recovery time.

Hopefully, the next one won't be so bad.

 

[Diane L. Evans]

JAMA and ACOG green journal several articles published
Below are references

1.Harmanli OH, Gentzler CK, Byun S, Dandolu MH, Grody T. Related Articles, Links
A comparison of abdominal and vaginal hysterectomy for the large uterus.
Int J Gynaecol Obstet. 2004 Oct;87(1):19-23.
PMID: 15464771 [PubMed - in process

2. Isik-Akbay EF, Harmanli OH, Panganamamula UR, Akbay M, Gaughan J, Chatwani AJ. Related Articles, Links
Hysterectomy in obese women: a comparison of abdominal and vaginal routes.
Obstet Gynecol. 2004 Oct;104(4):710-4.
PMID: 15458890 [PubMed - in process]


7: Harmanli OH, Khilnani R, Dandolu V, Chatwani AJ. Related Articles, Links
Narrow pubic arch and increased risk of failure for vaginal hysterectomy.
Obstet Gynecol. 2004 Oct;104(4):697-700.
PMID: 15458888 [PubMed - in process]

8: Kovac SR. Related Articles, Links
Clinical opinion: guidelines for hysterectomy.
Am J Obstet Gynecol. 2004 Aug;191(2):635-40.
PMID: 15343253 [PubMed - indexed for MEDLINE

11: McPherson K, Metcalfe MA, Herbert A, Maresh M, Casbard A, Hargreaves J, Bridgmen S, Clarke A. Related Articles, Links
Severe Complications of Hysterectomy: The VALUE Study.
Obstet Gynecol Surv. 2004 Sep;59(9):653-654.
PMID: 15329553 [PubMed - as supplied by publisher]

15: Aka N, Kose G, Gonenc I, Api M. Related Articles, Links
Tissue trauma after vaginal hysterectomy and colporrhaphy versus abdominal hysterectomy: a randomised controlled study.
Aust N Z J Obstet Gynaecol. 2004 Aug;44(4):328-31.
PMID: 15282005 [PubMed - in process]

17: Miskry T, Magos A. Related Articles, Links
A national survey of senior trainees surgical experience in hysterectomy and attitudes to the place of vaginal hysterectomy.
BJOG. 2004 Aug;111(8):877-9.
PMID: 15270942 [PubMed - indexed for MEDLINE]

21: Garry R, Fountain J, Brown J, Manca A, Mason S, Sculpher M, Napp V, Bridgman S, Gray J, Lilford R. Related Articles, Links
EVALUATE hysterectomy trial: a multicentre randomised trial comparing abdominal, vaginal and laparoscopic methods of hysterectomy.
Health Technol Assess. 2004 Jun;8(26):1-154.
PMID: 15215018 [PubMed - indexed for MEDLINE]

22: El-Toukhy TA, Hefni M, Davies A, Mahadevan S. Related Articles, Links
The effect of different types of hysterectomy on urinary and sexual functions: a prospective study.
J Obstet Gynaecol. 2004 Jun;24(4):420-5.
PMID: 15203584 [PubMed - indexed for MEDLINE]

28: Kovac SR. Related Articles, Links
Transvaginal hysterectomy: rationale and surgical approach.
Obstet Gynecol. 2004 Jun;103(6):1321-5.
PMID: 15172872 [PubMed - indexed for MEDLINE]

29: Roussis NP, Waltrous L, Kerr A, Robertazzi R, Cabbad MF. Related Articles, Links
Sexual response in the patient after hysterectomy: total abdominal versus supracervical versus vaginal procedure.
Am J Obstet Gynecol. 2004 May;190(5):1427-8.
PMID: 15167858 [PubMed - indexed for MEDLINE]

31: Malzoni M, Perniola G, Hannuna K, Iuele T, Fruscella ML, Basili R, Ebano V, Marziani R. Related Articles, Links
[A review of 445 cases of laparoscopic hysterectomy: benefits and outcome]
Clin Ter. 2004 Jan;155(1):9-12. Italian.
PMID: 15147074 [PubMed - indexed for MEDLINE]

52: Campbell ES, Xiao H, Smith MK. Related Articles, Links
Types of hysterectomy. Comparison of characteristics, hospital costs, utilization and outcomes.
J Reprod Med. 2003 Dec;48(12):943-9.
PMID: 14738021 [PubMed - indexed for MEDLINE]

54: Garry R, Fountain J, Mason S, Hawe J, Napp V, Abbott J, Clayton R, Phillips G, Whittaker M, Lilford R, Bridgman S, Brown J. Related Articles, Links
The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy.
BMJ. 2004 Jan 17;328(7432):129. Epub 2004 Jan 07. Erratum in: BMJ. 2004 Feb 28;328(7438):494.
PMID: 14711749 [PubMed - indexed for MEDLINE]

 

[LovelyRita]

...what a nightmare. I am not convinced of the advantages of this procedure over open laparotomy. The operation took almost 6 hours, was relatively without intraoperative complication, but will cost quite a bit more money, the patient still has a sown-together hole where her cervix used to be as well as three cigar-sized holes in the abdomen...anyone have a good article weighing the morbidity advantages of LAVH over open hysterectomy? All I can find are cost studies.

Six hours dude? What happened...? Complications/bleeding, etc? I was in on one yesterday and it took about 1 hour or so. I'd like to hear more about your experience for learning's sake.
-M.

 

[starayamoskva]

Six hours dude? What happened...? Complications/bleeding, etc? I was in on one yesterday and it took about 1 hour or so. I'd like to hear more about your experience for learning's sake.
-M.

Where you assisting on an LAVH or were you assisting on a total laparoscopic hyst, where they morselize (sp?) the entire uterus and remove it with the scope?
I can see the latter taking 6 hours as it is a completely new procedure, when they did the first one at our hospital it took about that long.