Comparative Study of Laparoscopically Assisted Vaginal Hysterectomy and Non-Descended Vaginal Hysterectomy

Background: This study explores the nuances of surgical approaches for hysterectomy, focusing on Laparoscopic Assisted Vaginal Hysterectomy (LAVH) and Non-Descent Vaginal Hysterectomy (NDVH). Hysterectomy, the removal of the uterus, is a common gynecologic surgery, often involving additional procedures like oophorectomy and salpingectomy. While abdominal hysterectomy is prevalent, there is a growing interest in minimally invasive techniques like LAVH. The study compares the efficacy, complications, and patient recovery experiences of LAVH, combining laparoscopic and vaginal methods, with the traditional NDVH, which relies solely on vaginal access.

Aim of the study: This study aims to compare the efficacy, complications, and patient recovery experiences of LAVH and NDVH.

Methods: In a prospective comparative study at BSMMU, Dhaka, 30 hysterectomy patients from July 2007 to December 2007 were divided into the LAVH and NDVH groups. Inclusion criteria involved dysfunctional bleeding, fibroid uterus (≤2 weeks), or adenomyosis signs, while exclusion criteria included uterine prolapse and other conditions. Joel-Cohen’s transvaginal hysterectomy technique or laparoscopically assisted vaginal hysterectomy (LAVH) under spinal or general anesthesia was performed based on randomization. Data analyzed various parameters, including operative time, blood loss, uterus weight, postoperative pain, and complications. Statistical analysis employed SPSS, reporting results using mean±SD for continuous and frequency/percentage for categorical parameters. Student’s t-test determined significance (P<0.05).

Result: The study compares age, parity, comorbidities, uterine sizes, operation times, blood loss, and clinical outcomes between Laparoscopy-Assisted Vaginal Hysterectomy (LAVH) and Non-descent Vaginal Hysterectomy (NDVH) in 30 patients. LAVH shows higher <40 age group representation (60%), lower mean age (42.4±3.9), and a trend toward increased parity in the 2-4 range (73.33%). Comorbidity distribution reveals differences in hypertension (HT) and diabetes prevalence. Uterine sizes exhibit insignificant variations. LAVH has longer operation times (145.3±30.5 minutes) and higher blood loss (92.35±10.26 ml) compared to NDVH (81.7±10.2 minutes, 60.50±17.02 ml). Clinical outcomes differ in 3rd-day haemoglobin levels and analgesic requirements. Overall, the findings highlight nuanced distinctions, emphasizing the importance of comprehensive evaluation.

Conclusion: This study compared laparoscopically assisted vaginal hysterectomy (LAVH) and non-descended vaginal hysterectomy (NDVH), finding that LAVH had a longer operation time but reduced the need for postoperative analgesics. No significant differences were observed in pain levels, disappearance, or discharge day. The prolonged LAVH operation time suggests NDVH is a viable alternative, especially where laparoscopic expertise is limited. The study underscores the importance of considering surgical proficiency and resources when choosing between these hysterectomy methods in a given geographical area.

Keywords: Hysterectomy, LAVH (Laparoscopic Assisted Vaginal Hysterectomy), NDVH (Non-Descent Vaginal Hysterectomy) and Visual analog scale.