A Randomized Comparison of Laparoendoscopic Single-Site Hysterectomies: Total Laparoscopic Hysterectomy Versus Laparoscopically Assisted Vaginal Hysterectomy

Background: To compare surgical outcomes of two procedures for laparoendoscopic single-site (LESS) hysterectomy: total laparoscopic hysterectomy (TLH) and laparoscopically assisted vaginal hysterectomy (LAVH).

Materials And Methods: Seventy-six patients who had an indication for hysterectomy for benign uterine disease were randomized to LESS-TLH or LESS-LAVH. Surgical outcomes were assessed and compared between the two groups.

Results: There were no differences in baseline demographics between the two groups. Surgical outcomes such as operative time, estimated blood loss, length of hospital stay, and complication rate were similar between the two groups. The failure rate in the LESS-TLH group was higher than that in the LESS-LAVH group (5/38 [11%] versus 0/38 [0%]), although this difference did not reach statistical significance (P=.054). Among the 5 cases that failed in the LESS-TLH group, 4 were related to a large lower uterine segment prohibiting visualization during colpotomy. The postoperative pain scores at 18 and 36 hours after surgery were significantly lower in the LESS-TLH group than in the LESS-LAVH group (all P<.001). Vaginal discharge at 1 and 4 weeks after surgery was significantly lower in the LESS-TLH group than in the LESS-LAVH group (all P<.001).

Conclusions: LESS-TLH and LESS-LAVH are both safe, feasible procedures with similar surgical outcomes. LESS-TLH was associated with less postoperative pain and less postoperative vaginal discharge, whereas LESS-LAVH may be preferred in patients with a uterus with a large lower uterine segment.