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  • Title: Laparoscopic hysterectomy. Supracervical vs. assisted vaginal.
    Author: Schwartz RO.
    Journal: J Reprod Med; 1994 Aug; 39(8):625-30. PubMed ID: 7996527.
    Abstract:
    Twenty cases of laparoscopic supracervical hysterectomy performed by operative laparoscopy without vaginal assistance were retrospectively compared to 232 cases of laparoscopically assisted vaginal hysterectomy reported in the literature. The specimens were morcellated intraabdominally and removed through the umbilicus. This is the first reported series of this technique with intraabdominal morcellation, which emphasizes cosmetic considerations and remains within the confines of the umbilicus. The postoperative hospitalization time ranged from 3.75 to 22.2 hours. On the second postoperative day, 10% of the patients returned to work, and 15% were able to drive. Patients resumed normal activity in an average of 5.6 days after surgery. As compared to laparoscopically assisted vaginal hysterectomy, there was a decrease in morbidity, blood loss and recovery time. Prolonged anesthesia from the longer operating time was clinically insignificant in terms of the patients' recovery. By decreasing the disability from hysterectomy from six weeks to one, the procedure provided financial savings through work time gained. A physician compared data on 20 women, 25-60 years old, who underwent laparoscopic supracervical hysterectomy (LSH) without vaginal assistance at HCA West Paces Medical Center in Atlanta, Georgia, between December 1991 and June 1992 with 232 cases reported in the literature of laparoscopically assisted vaginal hysterectomy (LAVH) with both vaginal and laparoscopic components. For the LSH, the uterus was morcellated intraabdominally and the pieces removed through the navel. Among LSH patients, the mean postoperative hospitalization time was almost 14 hours (range, 3.75-22.2 hours). It took an average of only 5.6 days after LSH to return to work or resume normal activity. Two women (10%) returned to work 2 days after the operation. Three women (15%) were able to drive 2 days after. Compared to LAVH patients, LSH patients experienced lower hospitalization (0.58 vs. 1.18-4.4 days), less blood loss (40 vs. 115.85 ml), less recovery time (5.6 vs. 7-35 days), and quicker return to normal sexual activity (10.2 vs 21 days) than did LAVH patients. The prolonged anesthesia associated with the longer operating time with LSH was not clinically significant in terms of patients' recovery. Even though hospital costs are higher with LSH than with total abdominal hysterectomy, LSH reduces the disability from hysterectomy from 6 weeks to 1 week, therefore providing financial savings through work time gained.
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