Review on laparoscopic hysterectomy

Abstract

An increasing number of data on laparoscopic hysterectomy has become available since the procedure was introduced in 1989. This article reviews all published series till June 1995, totaling 4502 cases. Prior to this procedural evaluating strategy is addressed to highlight the short-comings of such a review. Most data are collected retrospectively in a lunited number of centers, all dedicated to the procedure. Laparoscopy Assisted Vaginal Hysterectomy (LAVH) may cover a whole range of procedures, and a classification system is needed. It is suggested that classification systems based on the degree of anatomical dissection is clinically most relevant. During 76.1% of LAVH-procedures, the uterine artery is ligated laparoscopically, though the fraction of total laparoscopic hysterectomies is minimal (1.5%). Mean conversion rate is 2.5% and mean major complication rate is 3.24% (range 0-20%). Urinary tract lesions (1.42%), such as bladder perforation, and reintervention for haemorrhage (0.78%), are the most frequent complications. LAVH seems an efficacious procedure, more data on its effectiveness are urgently needed.