Standardization of laparoscopically assisted vaginal hysterectomy for uterine myoma and uterine adenomyosis at a single institution

Kikuko Okada, Mitsuru Shiota, Yasushi Kotani, Masahiko Umemoto, Takako Tobiume, Natsuki Ugajin, Hiroshi Hoshiai
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2012 · vol. 28(1) , pp. 426–432 · doi:10.5180/jsgoe.28.426 · W2316633878
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study compared laparoscopic hysterectomies performed by experts and non-experts, finding no differences in complications and establishing the procedure as standardized for uterine myoma and adenomyosis.

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The study evaluated whether laparoscopically assisted vaginal hysterectomy (LAVH) could be standardized at a single institution for patients with uterine myomas and uterine adenomyosis by comparing 282 LAVH cases (1995–2001) done by experts, 258 cases (2002–2010) by experts, and 83 cases performed by non-expert Ob/Gyn surgeons. Across groups, patients were compared for age and parity, with uterine weight, operative time, blood loss, intraoperative conversion to open surgery, and intra- and post-operative complications. No significant differences were found in age, parity, blood loss, or conversion to open surgery, while the non-expert group had significantly lower uterine weight and longer operative time; the authors concluded LAVH could be performed by all gynecological surgeons and noted an increasing annual LAVH rate from 16.2% (1995) to 85.7% (2010). This paper is centrally about endometriosis and/or adenomyosis — specifically uterine adenomyosis, as it studies standardization of LAVH in patients with uterine adenomyosis.

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Abstract

Objective: Total vaginal hysterectomy (TVH) and total abdominal hysterectomy (TAH) are presently the standard procedures for total hysterectomy. Since the advent of laparoscopically assisted vaginal hysterectomy (LAVH), our institution has actively performed LAVH to establish it as standardized procedure for patients with uterine myomas and those with uterine adenomyosis. This report investigates the parameters to determine LAVH to be considered a standardized procedure. Method: In our institution, 282 LAVH cases were performed from 1995 to 2001 (Group I), 258 cases from 2002 to 2010 (Group IIa) by "experts", and 83 cases by non-expert Ob/Gyn surgeon (Group IIb). The groups were compared by age and parity of the patients; uterine weight; operative time; blood loss; rates of intraoperative conversion to open surgery; and intra- and post-operative complications. The trend in the annual rate of LAVH was also examined.Results: There were no significant differences in age, parity, blood loss, or conversion to open surgery. Uterine weight was significantly lower (350g) and operative time significantly longer (163min) in Group IIb than in Groups I (400g/143min) and IIa (411g/143min). The annual LAVH rate has increased continually, from 16.2% in 1995 to 85.7% in 2010.Discussion: Because no difference was observed in blood loss or complication rates among the three groups of patients, the authors have concluded that LAVH can be performed by all gynecological surgeons. Presently, LAVH is performed for the majority of patients requiring total hysterectomy. Therefore, LAVH has been established as the institution's standardized procedure for total hysterectomy.
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Abstract

Objective: Total vaginal hysterectomy (TVH) and total abdominal hysterectomy (TAH) are presently the standard procedures for total hysterectomy. Since the advent of laparoscopically assisted vaginal hysterectomy (LAVH), our institution has actively performed LAVH to establish it as standardized procedure for patients with uterine myomas and those with uterine adenomyosis. This report investigates the parameters to determine LAVH to be considered a standardized procedure.

Method

In our institution, 282 LAVH cases were performed from 1995 to 2001 (Group I), 258 cases from 2002 to 2010 (Group IIa) by "experts", and 83 cases by non-expert Ob/Gyn surgeon (Group IIb). The groups were compared by age and parity of the patients; uterine weight; operative time; blood loss; rates of intraoperative conversion to open surgery; and intra- and post-operative complications. The trend in the annual rate of LAVH was also examined.

Results

There were no significant differences in age, parity, blood loss, or conversion to open surgery. Uterine weight was significantly lower (350g) and operative time significantly longer (163min) in Group IIb than in Groups I (400g/143min) and IIa (411g/143min). The annual LAVH rate has increased continually, from 16.2% in 1995 to 85.7% in 2010.

Discussion

Because no difference was observed in blood loss or complication rates among the three groups of patients, the authors have concluded that LAVH can be performed by all gynecological surgeons. Presently, LAVH is performed for the majority of patients requiring total hysterectomy. Therefore, LAVH has been established as the institution's standardized procedure for total hysterectomy.

Method

In our institution, 282 LAVH cases were performed from 1995 to 2001 (Group I), 258 cases from 2002 to 2010 (Group IIa) by "experts", and 83 cases by non-expert Ob/Gyn surgeon (Group IIb). The groups were compared by age and parity of the patients; uterine weight; operative time; blood loss; rates of intraoperative conversion to open surgery; and intra- and post-operative complications. The trend in the annual rate of LAVH was also examined.

Results

There were no significant differences in age, parity, blood loss, or conversion to open surgery. Uterine weight was significantly lower (350g) and operative time significantly longer (163min) in Group IIb than in Groups I (400g/143min) and IIa (411g/143min). The annual LAVH rate has increased continually, from 16.2% in 1995 to 85.7% in 2010.

Discussion

Because no difference was observed in blood loss or complication rates among the three groups of patients, the authors have concluded that LAVH can be performed by all gynecological surgeons. Presently, LAVH is performed for the majority of patients requiring total hysterectomy. Therefore, LAVH has been established as the institution's standardized procedure for total hysterectomy. © 2012 Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy Favorites & Alerts Recently viewed articles

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adenomyosis

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