This clinical study was conducted to survey on the 500 cases of pelviscopic assisted vaginal hysterectomy(PAVH) and to compare with total abdominal hysterectomy(TAH) of same size at department of Obstetrics and Gynecology, Chung-Ang University,
Young
San Hospital from May, 1991 to June, 1994.
The mean age of the patients for PAVH was 43.6±6.9 years old and mean parity was 2.5±1.2.
The major surgical indication for PAVH was myoma uteri comprising 79.2% and other minor indications were dysmenorrhea and pelvic pain(7.4%), pelvic inflammatory disease(4.6%), dysfunctional uterine bleeding (3.0%), cervical intraepithelial
neoplasia(3.0%), etc in order to frequencies.
The pelviscopic operations were performed through usage of the techniques of videolaparoscopy including a combination of bipolar forceps for hemostasis, scissors and/or Nd-YAG laser for tissue division, excision, lysis of adhesions and cutting.
The
Endo
GIA stapler was used in 60 cases for transection the tissues, comprising 12% of total cases.
The most concomitant procedure with PAVH was anterior and/or posterior colpoperineorrhaphy, which comprise 35.4%. Incidental appendectomy(18.2%), salpingo-oophorectomy (10.2%) and adhesiolysis(6.2%) were also carried out concomitantly.
The mean operating time for overall PAVH cases was 116.0±36.5 minutes, which was not significantly different from that of TAH, but operating time was significantly reduced by use of Endo-GIA stapler during PAVH.
In comparison with TAH, the mean hospital stay after PAVH and amount of blood transfusion were significantly reduced.
The mean uterine weight in PAVH cases was 189.6±104.1gm, which was significantly smaller than that of TAH cases.
the complications were noted in 22 out of 500 cases, comprising 4.4%. The major complication for PAVH was urinary tract infection. In comparison with TAH, wound infection and ileus were marked reduced in PAVH cases.
Our finding suggest that PAVH has advantages of shorter hospitalization, smaller blood loss, shorter operating times in cases of using Endo-GIA stapler, reduced postoperative morbidity and avoidance of abdominal scars in comparison with
conventional
abdominal hysterectomy.
|