Total laparoscopic hysterectomy versus vaginal assisted laparoscopic hysterectomy for benign uterine conditions: A prospective trial.

Objective: To compare the technique of total laparoscopic hysterectomy (TLH) and laparoscopic assisted vaginal hysterectomy (LAVH) in order to identify the procedure with better outcome. Study Design: Prospective Comparative study. Setting: Northwest General Hospital and Research Center and Lady Reading Hospital, Peshawar. Period: 1st Jan, 2018 till 31st Dec, 2022. Methods: All the patient presenting in out-patient department needing hysterectomy with benign pathologies, perimenopausal age group, size of the uterus ≤12 weeks and with no previous history of abdominal surgery were placed alternatively in to two groups. Group A included patients who were supposed to undergo Total Laparoscopic Hysterectomy, where uterus was supposed to be delivered vaginally and vault was to be repaired via intracorporeal sutures over uterine manipulator. While group B included patients who were to be operated by Hybrid laparoscopic/vaginal technique and vault was to be repaired vaginally after delivering the uterus vaginally. Data was collected, placed on SPSSR version 16.0 and data was analyzed. Results: 62 patients were included in this study and were placed alternatively in to each group. The demographic values of both groups showed no significant differences for age, BMI and preoperative hemoglobin levels. The higher age group presenting with dysfunctional uterine bleeding was insignificantly more common in Group A whereas fibroids were more common in group B, yet a non-significantly higher age was recorded in group B. Conclusion: Both Laparoscopic assisted Vaginal hysterectomy (LAVH) and Total Laparoscopic hysterectomy (TLH) are feasible options for benign uterine pathology with lesser operative time in hysterectomy performed by the TLH method. The Total laparoscopic Hysterectomy (TLH) results in lower per-operative and post-operative blood loss as compared to the Laparoscopic assisted vaginal technique (LVAH).