Purpose: the laparoscope can be used to convert an abdominal into a vaginal hysterectomy when there are contraindications for the vaginal approach, and not as a substitute for simple vaginal hysterectomy. The purpose of the present study is to discuss the role of laparoscopy in vaginal hysterectomy. Methods: between February 1995 and September 1998, 400 patients were considered candidates for vaginal hysterectomy.Exclusion criteria included uterine prolapse, adnexal tumor and uterine immobility. The Heaney technique was used, and different morcellation procedures were employed for the removal of enlarged uteri. Results: the mean age and parity was 46.9 years and 3.2 deliveries, respectively. Twenty-nine patients (7.2%) were nulliparous, and 104 (26.0%) had never delivered vaginally. Three hundred and three patients (75.7%) had a history of previous pelvic surgery, the most common being cesarean section (48.7%). The most frequent indication was leiomyoma (61.2%), and the mean uterine volume was 239.9 cm³ (30-1228 cm³). Vaginal hysterectomy was successfully performed in 396 patients (99.0%), and 73 surgeries (18.2%) were done by residents. The mean operative time was 45 min. Diagnostic/operative laparoscopy was performed in 16 patients (4.0%). Intraoperative complications included 6 cystotomies (1.5%) and one rectal laceration (0.2%). There were four conversions (1.0%) to the abdominal route. Postoperative complications occurred in 24 patients (6.0%). Two hundred and eighty-one patients (70.2%) were discharged 24 h after surgery. Conclusions: the laparoscope does not seem to be necessary in cases were the uterus is mobile and there is no adnexal tumor. The main role of the laparoscope may be to increase the awareness of gynecologists to the possibility of a simple vaginal hysterectomy in the majority of cases.
Hysterectomy; Laparoscopy; Vaginal surgery; Surgery