Assessing the Impact of Introducing Laparoscopically Assisted Vaginal Hysterectomy into a Community-Based Gynecology Practice

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Abstract
This study was undertaken to determine the effects of introducing laparoscopically assisted vaginal hysterectomy (LAVH) into a community-based gynecology practice on the route of hysterectomy, operating time, patient costs, length of hospitalization, and morbidity, including complications and blood loss. All patients in the author's practice who had hysterectomies during the 10 months before completion of an advanced operative laparoscopy course were compared with the patients having a hysterectomy in the 10 months after the course. The route of hysterectomy, surgery time, length of hospital stay, preoperative and postoperative hemoglobin, uterine weight, diagnoses, and historical clinical data were compared between the two groups using a level of significance (α = 0.01) to assess statistical relevance. The rate of vaginal hysterectomy was remarkably higher in the AFTER group (53.2%, n = 62) vs the BEFORE group (27.7%, n = 65). The AFTER group had a significantly shorter hospital stay (3.4 days ± 1.22 vs 4 days ± 1.26, p ≤ 0.01) but a much longer surgery time (115.9 min ± 38.98 vs 80.1 min ± 27.95, p ≤ 0.01). There was no real difference in complication rates or fall in hemoglobin between the two groups. When LAVH was compared with TAH, the LAVH patients tended to be younger (37.4 ± 8.66 vs 46.2 ± 16.5 years) and to have a shorter hospital stay (3.1 ± 0.99 vs 4.1 ± 1.27 days), a longer surgery time (114.9 ± 37.45 vs 85.3 ± 33.74 min), and a bigger hospital bill ($6245 ± 380 vs $5140 ± 410) than patients with TAH. LAVH can be safely introduced into a community-based gynecology practice with proper training and experience. A significant decrease in the rate of abdominal hysterectomy and a subsequent shortening of hospitalization should be expected. However, the operating time will be lengthened significantly, and total hospital charges may be higher. (J GYNECOL SURG 11:71, 1995)