Comparison of clinical effects between total vaginal hysterectomy and total laparoscopic hysterectomy on large uteruses over 300 grams

OBJECTIVE: To compare intra- and postoperative complications, operation time, and duration of hospital stay, and to evaluate cost-effectiveness between total vaginal hysterectomy (TVH) and total laparoscopic hysterectomy (TLH) groups. MATERIAL & METHODS: Patients undergoing TVH or TLH for a large uterus weighing more than 300 g were recruited from January to December 2007: 150 cases of TVH and 100 cases of TLH, were used. Evaluated variables are as follows: age, parity, previous surgical history, intra- and postoperative complications, hysterectomy specimen weight, operation time, duration of hospital stay and total cost. Total cost ($US) include admission, anesthesia and operation costs. RESULTS: There was no difference in demographics, intra- and postoperative complications, and uterine weight. However, operation time in TLH (mean, 179.9 min) was significantly longer than TVH (mean, 93.8 min; P < 0.05). The mean length of hospital stay was 6.13 days in TVH group and 5.78 days in TLH group, respectively (P < 0.05). TVH was more cost-effective than TLH. There was significant difference in total cost between the two groups (TVH, mean $1815.7 vs TLH, mean $2560.5; P < 0.05). When the total cost was analyzed in detail, there was no difference in admission cost. However, the significant mean differences in anesthesia cost (TVH, $165 vs TLH, $245) and operation cost (TVH, $30.3 vs TLH, $768) were demonstrated (P < 0.05). CONCLUSION: TVH should not be abandoned for cases with a large uterus, and skilled surgeons for vaginal approach should preferentially perform TVH rather than TLH for the management of large uteruses.