A Journey from Lap-Assisted Vaginal Hysterectomy (LAVH) to Total Laparoscopic Hysterectomy (TLH)

Objective: Purpose of the study was to determine the challenges, complications and outcome of laparoscopic hysterectomy (LAVH & TLH). Study Design: Case series study. Place and Duration of Study: The study was conducted in Civil Hospital Bahawalpur from 1 October 2016 to 30 September 2017. Materials and Methods: Patient presenting with DUB (Dysfunctional Uterine Bleeding) and small fibroid were included. Parameters studied were duration of surgery, complications, conversion to open, patient satisfaction and hospital stay. Data was collected on performa and shifted to SPSS version 20. Results: Out of 11 patients included, 3 patient underwent Lap-assisted vaginal hysterectomy and in 8 patient TLH was performed. One patient was converted to open due to uncontrolled bleeding. One patient developed vesico-vaginal fistula. Minor postoperative wound infection (2 Patients) and wound infection (1 Patient) was managed conservatively. Conclusion: The challenges/complications of TLH are its technique, training, use of gadgetry, unfamiliar anatomy, bleeding and gas leakage. Proper training, use of uterine manipulator, best assisting technique and use of energy devices make outcome acceptable, easy and achievable.