Implications of Performing Laparoscopic-Assisted Vaginal Hysterectomy Versus Abdominal Hysterectomy on Suitable Patients in a South African Hospital Setting (Research Article) (Clinical Report‪)‬

Since the first case report of laparoscopic hysterectomy (LH) by Reich et al., (1) this minimally invasive technique is being increasingly utilised. The advantages of LH are similar to those of vaginal hysterectomy (VH), including minimal postoperative discomfort and less need for analgesics, a shorter stay in hospital and quicker return to normal daily activities. There are also fewer postoperative complications, and hospital costs are reduced. (2-4) Hysterectomy is one of the most commonly performed operations in developed countries. It is estimated that approximately 20% of women living in England and Wales will have undergone a hysterectomy before the age of 55. (5) Most surgeons perform up to 80% of procedures by the abdominal route. (6) This can in part be explained by personal preference, but is mainly due to lack of training and experience leading to reluctance to perform VH in nulliparous women in the presence of uterine enlargement or in women with previous pelvic surgery or previous caesarean section. The above factors should not be considered contraindications to VH, and there are publications that support this view. (7,8) The rationale for LH is to convert an abdominal hysterectomy (AH) into a laparoscopic/vaginal procedure and thereby reduce trauma and morbidity. In the USA before the introduction of LH, only 23% of women under the age of 60 underwent VH. The introduction of LH increased the proportion of VHs to 33%. (9)