The medical and economic impact of laparoscopically assisted vaginal hysterectomy in a large, metropolitan, not-for-profit hospital

Objective: Our purpose was to evaluate the medical and economic impact of operative laparoscopy on the surgical approach to hysterectomy for benign disease in a large, metropolitan, not-for-profit hospital. Study design: Retrospective analyses were performed on 2563 hysterectomies (without vaginal or bladder repair) for benign disease, performed and stapling devices were not used at any time during the study period. Electrosurgery and sutures were used for hemostasis. Parameters analyzed included surgical approach (total abdominal hysterectomy, vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy, and failied laparoscopically assisted vaginal hysterectomy), operative time, postoperative diagnosis, operative blood loss, length of stay, complications, uterine weight, and hospital changes. Changes in each of these parameters were analyzed and compared in 6-month increments. Results: During the study period the percent of hysterectomies performed abdominally declined from 65% to 36%. Laparoscopically assisted vaginal hysterectomy increased from 12% to 45%, and vaginal abdominal hysterectomy, 102 minutes (=2.3 minutes) for laparoscopically assisted vaginal hysterectomy, and 63 minutes (±2 minutes) for vaginal hysterectomy. Hospital stay was 68 hours (±1.5 hours) for total abdominal hysterectomy, 44 hours (±1.2 hours) for laparoscopically assited vaginal hysterectomy, and 43 hours (±4.1 hours) for vaginal hysterectomy. The average hospital charge was $6552 (±$108) for total abdominal hysterectomy, $6431 (±$100) for laparoscopically assisted vaginal hysterectomy, and $5869 (±$116) for vaginal hysterectomy. Conclusions: Contrary to previously published studies, our study demonstrates (1) laparoscopically assisted vaginal hysterectomy is a cost-effective procedure when performed with reusable instruments, (2) laparoscopically assisted vaginal hysterectomy is a safe procedure, even when performed by a variety of gynecologists with different skill levels, and (3) the number of hysterectomies performed abdominally was decreased by 29% without incurring more complications or reducing the number of vaginal cases.