[Operating time of laparoscopically assisted vaginal hysterectomy (LAVH)--the causative factors and the course of the postoperative period]

OBJECTIVES: The aim of the study was to find the causative factors of prolongation of the operating time of laparoscopically assisted vaginal hysterectomy (LAVH) and to analyse the influence of the operating time on the course of the postoperative period. MATERIAL AND METHODS: Retrospective analysis of 103 LAVH procedures performed from June 2002 to April 2006 for benign conditions. All the cases have been divided in two groups, depending on the operating time: 45 procedures up to 90 minutes (average 76, range 50-90) and 58--over 90 minutes (average 126, range 95-210). In both groups we have analysed patient characteristics, indications, uterine size, intra- and postoperative complications, blood loss, hospital stay, the day of the return to the general diet, anaesthetic and antibiotic demand in postoperative period. RESULTS: There were 42.2% of postmenopausal patients in the "short-time" LAVH group and 17.2% in the "long-time" LAVH group (p < 0.05). 8.9% women in the short LAVH group and 31.0% in the long LAVH group had had no vaginal deliveries (p < 0.05). There was no significant difference in previous surgery history between the groups. Significant correlation of operating time of LAVH with patient weight (r = 0.26, p < 0.01) and BMI (Body Mass Index) (r = 0.21, p < 0.05) was noted. Uterine size was bigger in the long LAVH group (p < 0.01). There was one intraoperative complication (bowel injury) and three postoperative ones (two cases of bleeding to abdominal cavity demanding reoperation and one to the abdominal wall from injured superficial epigastric artery), all occurred in the long LAVH group. The average perioperative decrease in haemoglobin concentration was insignificantly higher in the long LAVH group (2.0 g% vs 1.4%). There was 4.4% rate of antibiotic demand after the short LAVH procedures and 24.1% after the long ones (p < 0.05). There was no significant difference in anaesthetic demand. The average day of introducing the general diet was 1,0 (range 1-2) in the short LAVH group and 1,4 (range 1-5) in the long LAVH group (p < 0.05). The average hospital stay was 2,6 days after the short LAVH procedures and 3,3 days after the long ones (p < 0.05). CONCLUSIONS: The operating time of LAVH depends on operator experience, obstetric history, presence or absence of the menstrual cycles, uterine size and, probably, patient weight and BMI. After the long LAVH procedure antibiotic use is more common, return to the general diet takes place later and hospital stay is prolonged.