Is laparoscopically-assisted vaginal hysterectomy associated with low operative morbidity?

Seventy-one consecutive patients undergoing laparoscopically-assisted vaginal hysterectomy were prospectively evaluated with particular emphasis on the operative morbidity. Bipolar desiccation was the mainstay for haemostasis. Fibroids accounted for two-thirds of the uterine pathology and the average uterine weight was 238.0 g (SD 134.6). Mean operating time was 126.3 minutes (SD 36.9) and decreased with experience despite the progressive increase in uterine weight. The mean blood loss was 432 mL (SD 288) with a mean haemoglobin change of 2.3 g/dL (SD 1.5). Intraoperative complications occurred in 5 patients (7.0%), 2 with inferior epigastric artery injuries and 3 serosal bladder injuries. Postoperative complications occurred in 45 patients (63.4%). Febrile morbidity was the major complication and occurred some 50% of patients, 45% of whom had no underlying cause identified. Vault haematoma was the second most common complication and occurred in 31.0%. The mean hospital stay was 5.4 days (SD 2.7) and the readmission rate was 10%. Our results of laparoscopically-assisted vaginal hysterectomy did not conform with the benefits of reduced blood loss, shorter hospital stay and reduced postoperative complications reported in the literature. The true complication rate of laparoscopically-assisted vaginal hysterectomy should be carefully assessed before this can be considered as the approach of choice to hysterectomy.