3612
document
Identifying the indications for laparoscopically assisted vaginal hysterectomy : a prospective , randomised comparison with abdominal hysterectomy in patients with symptomatic uterine fibroids . OBJECTIVE To compare laparoscopically assisted vaginal hysterectomy ( LAVH ) and total abdominal hysterectomy ( TAH ) in patients with uterine fibroids . DESIGN A prospective randomised study . SETTING The San Paolo Hospital , Milan . POPULATION Sixty-two patients , who were not suitable for a vaginal hysterectomy , requiring treatment for uterine fibroids . METHODS Randomisation between LAVH and TAH . Comparison of outcomes on the whole series , patients with uteri < or = 500 g ( Group 1 ) and patients with uteri > 500 g ( Group 2 ) . MAIN OUTCOME MEASURES To establish operating time , blood loss , complications , febrile morbidity , analgesics administration and hospital stay for both treatment approaches . RESULTS Median uterine weight was 400 g in both LAVH and TAH group . Median operating time was longer for LAVH ( 135 min compared with 120 min for TAH ; P = 0.001 ) , but patients undergoing LAVH had less analgesics administration ( 23 % compared with 77 % , P < 0.001 ) and a shorter median hospital stay ( 3.8 compared with 5.8 days ; P < 0.001 ) . LAVH , when compared with TAH in the two weight subgroups , required a significantly longer operating time only in Group 2 , significantly reduced analgesics administration only in Group 1 , and significantly reduced hospital stay in both groups . Conversions of LAVH to laparotomy were significantly more frequent in Group 2 ( 3/11 ) than in Group 1 ( 0/20 ) ( P = 0.04 ) . CONCLUSIONS Compared with TAH , LAVH has advantages in removing uteri weighing < or = 500 g , with comparable operating time , less post-operative pain and shorter recovery . Among uteri weighing > 500 g LAVH showed a shorter recovery , but longer operating time than TAH and a 27 % rate of conversion to laparotomy .
3613
Intervention_Surgical
laparoscopically assisted vaginal hysterectomy
3614
Intervention_Physical
abdominal hysterectomy
3615
Intervention_Surgical
laparoscopically assisted vaginal hysterectomy ( LAVH )
3616
Intervention_Surgical
total abdominal hysterectomy ( TAH )
3617
Intervention_Surgical
LAVH
3618
Intervention_Physical
TAH
3619
Intervention_Surgical
LAVH
3620
Intervention_Physical
TAH
3621
Intervention_Surgical
LAVH
3622
Intervention_Physical
TAH
3623
Intervention_Surgical
LAVH
3624
Intervention_Physical
LAVH
3625
Intervention_Physical
TAH
3626
Intervention_Physical
TAH
3627
Intervention_Surgical
LAVH
3628
Intervention_Surgical
LAVH
3629
Intervention_Physical
TAH
3630
Intervention_Physical
laparotomy
3631
Outcome_Other
operating time
3632
Outcome_Physical
blood loss
3633
Outcome_Adverse-effects
complications
3634
Outcome_Mortality
febrile morbidity
3635
Outcome_Other
analgesics administration
3636
Outcome_Other
hospital stay
3637
Outcome_Physical
Median uterine weight
3638
Outcome_Other
Median operating time
3639
Outcome_Physical
analgesics administration
3640
Outcome_Other
median hospital stay
3641
Outcome_Other
operating time
3642
Outcome_Physical
analgesics administration
3643
Outcome_Other
hospital stay
3644
Outcome_Other
advantages
3645
Outcome_Other
operating time
3646
Outcome_Pain
post-operative pain
3647
Outcome_Physical
recovery
3648
Outcome_Physical
conversion to laparotomy
3649
Participant_Condition
symptomatic uterine fibroids
3650
Participant_Condition
uterine fibroids
3651
Participant_Sample-size
Sixty-two
3652
Participant_Condition
uterine fibroids