From the Guidelines
Yes, a vaginal hysterectomy (VH) and a laparoscopic vaginal hysterectomy (LVH) are performed differently. A vaginal hysterectomy is performed entirely through the vagina, with no abdominal incisions. The surgeon accesses and removes the uterus through the vaginal canal, making it less invasive. In contrast, a laparoscopic vaginal hysterectomy (more commonly called laparoscopically-assisted vaginal hysterectomy or LAVH) combines two approaches: it uses both small abdominal incisions for laparoscopic instruments and cameras to visualize and partially detach the uterus from above, followed by removal through the vagina. The laparoscopic component allows better visualization of the pelvic organs and is particularly helpful for patients with conditions like endometriosis, large fibroids, or adhesions that might make a standard vaginal approach difficult. Recovery time for both procedures is typically shorter than open abdominal hysterectomy, though the purely vaginal approach generally offers the quickest recovery when anatomically feasible. The choice between these procedures depends on the patient's specific anatomy, underlying condition, surgeon expertise, and whether additional procedures like removal of ovaries or lymph nodes are needed, as noted in the most recent study 1. This study highlights the importance of considering the latest evidence in guiding surgical decisions for optimal patient outcomes. Key factors influencing the choice between VH and LVH include the patient's overall health, the presence of any complicating factors, and the surgeon's expertise in performing these procedures, as emphasized in 1. Ultimately, the decision should prioritize minimizing morbidity, mortality, and maximizing quality of life for the patient.
From the Research
Differences in Surgical Approach
- A vaginal hysterectomy (VH) and a laparoscopic vaginal hysterectomy (LVH) are performed differently, with distinct advantages and disadvantages associated with each approach 2, 3, 4, 5, 6.
- VH is considered the gold standard for benign pathologies and is preferred over abdominal hysterectomy whenever possible, while LVH is recommended when VH is not technically feasible 2, 3.
Surgical Outcomes
- Studies have shown that VH is associated with shorter operative times, less blood loss, and shorter hospital stays compared to LVH 4, 5, 6.
- However, LVH is associated with lower blood loss and shorter hospital stays in some cases, and allows for the treatment of additional pathologies and bilateral salpingo-oophorectomy (BSO) 2, 4, 6.
- The choice of surgical approach depends on various factors, including the surgeon's expertise, the patient's condition, and the presence of contraindications such as a narrow pelvis or endometriosis 3, 5.
Comparison of Surgical Techniques
- Total laparoscopic hysterectomy (TLH) and non-descent vaginal hysterectomy (NDVH) have been compared in terms of perioperative outcomes, with NDVH showing advantages in terms of scarless surgery, shorter operative time, and fewer complications 3.
- However, TLH is associated with better postoperative parameters and patient satisfaction, although it is a more time-consuming procedure that requires laparoscopic surgical expertise 3, 4.
- Laparoscopically assisted vaginal hysterectomy (LAVH) and VH have also been compared, with VH showing shorter operative times, less blood loss, and shorter discharge times 5.