LAS VEGAS — Laparoscopic supracervical hysterectomy for the nonprolapsed uterus was associated with significantly shorter hospital stays, compared with laparoscopic-assisted vaginal hysterectomy, but all other perioperative measures were similar between the two procedures, results from a retrospective analysis showed.
But no definitive conclusions can be made as to the preferred procedure for a patient with a nonprolapsed uterus. This is in contrast to some of the previously published reports that compared laparoscopic-assisted vaginal hysterectomy (LAVH) with laparoscopic supracervical hysterectomy (LSH), “all of which are retrospective, relatively small case series and have findings that do not seem to be consistent,” Dr. Ali Ghomi cautioned at the annual meeting of the AAGL. “There are no randomized clinical trials comparing LAVH to LSH, and most studies did not account for pelvic organ prolapse as a confounding factor in LAVH. So before we make any shift to one procedure or another, we need to examine the available evidence very carefully and not jump to conclusions.”
To compare the perioperative outcomes of the two procedures when performed for the nonprolapsed uterus, Dr. Ghomi and his associates from Harvard Medical School, Boston, and the State University of New York at Buffalo, where he is a member of the department of gynecology-obstetrics, evaluated 248 successive cases of LAVH and 173 successive cases of LSH between January 2001 and December 2007. The study is the largest of its kind to date.
Patient demographics were similar between the two groups, reported Dr. Ghomi, who had no conflicts to disclose. The mean age of patients was 43 years, and their mean body mass index was 28 kg/m2.
There was no significant difference in the mean operating time between both groups (145 minutes for the LAVH vs. 143 minutes for the LSH group) or in the rate of perioperative complications (19% vs. 15%, respectively). Postoperative hemoglobin change and febrile morbidity were similar between the groups.
Hospital stay was significantly shorter for women in the LSH group, compared with their counterparts in the LAVH group (a mean of 1.2 days vs. 1.6 days, respectively). Potential confounders to this relationship such as perioperative complications, intraoperative conversion to laparotomy, postoperative fever, and hemoglobin change did not differ significantly between the two groups.
“Shorter hospital stay in LSH is an interesting observation that might suggest overall faster patient recovery,” Dr. Ghomi said in a later interview. “Shorter hospital stay in LSH might also offset the cost of disposable instruments utilized in LSH, when compared to LAVH. Large randomized clinical trials are needed to further investigate the superiority of either of these two minimally invasive surgical alternatives to abdominal hysterectomy.”