The use of laparoscopic techniques now permits combination of benefits of both abdominal and vaginal hysterectomy. But, laparoscopic hysterectomy has been associated with a higher risk of urinary tract injury compared with abdominal and vaginal procedures, and the risks of these minimally invasive approaches must be balanced with the benefits. Hand-assisted laparoscopic surgery was first described in the early 1990s as a surgical method designed to facilitate the performance of challenging laparoscopic procedures while maintaining the advantages of a minimally invasive approach.

Our present study aims to compare between laparoscopicassisted vaginal hysterectomy (LAVH) and hand-assisted laparoscopic hysterectomy (HALH).

This study was conducted at the Oncology Center of Mansoura University (OCMU). A total of 41 sequential patients scheduled for hysterectomy were divided randomly (patient by patient) into two groups: group 1 included 21 patients who underwent LAVH and group 2 included 20 patients who underwent HALH from August 2010 to March 2013.

Patients were excluded from this study if they had contraindications to either vaginal hysterectomy, such as several prior abdominal surgeries, vaginal stenosis, or severe endometriosis, or to laparoscopy, including underlying medical conditions that could be worsened by pneumoperitoneum or the Trendelenburg position. Body mass index was not a limiting factor for patient inclusion in the study.

The clinical characteristics of the 41 patients were similar as regards age, parity, and uterine size. The indications for hysterectomy among the study groups were nearly similar. No statistically significant difference was found between the two groups in operative time. Operative blood loss was higher in the LAVH group. Two cases in the LAVH group were converted to laparotomy to control bleeding and to repair a urinary bladder tear.

The HALH group had less analgesic consumption, earlier ambulation, shorter hospital stay, and earlier regain of daily and coital activities. On the contrary, the HALH group had much more direct costs, which requires much effort to be directed toward this fruitful technique and more training programs to surgeons to increase their experience in enriching hand skills in this emerging technique.

Kotb SZ, El-Metwally M, Shams N, Khater A. Laparoscopic-assisted Vaginal Hysterectomy vs Hand-assisted Laparoscopic Hysterectomy. World J Lap Surg 2016;9(2):63-70.