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• W3148548719 abstract "We read with interest the article by Agostini et al1Agostini A. Vejux N. Bretelle F. Collette E. De Lapparent T. Cravello L. et al.Value of laparoscopic assistance for vaginal hysterectomy with prophylactic bilateral oophorectomy.Am J Obstet Gynecol. 2006; 194: 351-354Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar who concluded that laparoscopic assistance is not useful in performing vaginal hysterectomies with prophylactic bilateral oophorectomies. They reported a higher complication rate in patients who had a procedure with laparoscopic assistance. The conclusions of this article cannot be accepted without comments. First, Garry et al2Garry R. Fountain J. Mason S. Hawe J. Napp V. Abbott J. et al.The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy.BMJ. 2004; 328: 129-133Crossref PubMed Google Scholar who compared 336 laparoscopic and 168 vaginal hysterectomies, concluded that their prospective trial was underpowered to study differences in complication rates. Therefore, when only 24 patients were included in each group it seems impossible to propose any conclusion. The number of patients necessary in each group was calculated from complication rates in a retrospective series of 60 patients with complication rates of 65% and 23% in the laparoscopic and vaginal groups, respectively. It seems surprising to design and to authorize a prospective randomized study when there is such a difference between the 2 techniques. Second, the higher complication rate observed in the laparoscopic assistance group should not be attributed to this approach. As the quality of hemostasis is generally accepted as one of the advantages of endoscopic surgery,3Johnson N. Barlow D. Lethaby A. Tavender E. Curr L. Garry R. Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials.BMJ. 2005; 330: 1478-1486Crossref PubMed Scopus (343) Google Scholar cases of hemorrhage that occurred during surgery were probably not related to the laparoscopic part of the procedure. The same comment applies to the vaginal cuff, which was treated vaginally, and any vaginal hematomas would not have been induced by the laparoscopic assistance. Third, abnormal disorders (endometriosis or adhesions) were discovered in 15% of the patients who had surgery for dysfunctional uterine bleeding in the Evaluate study. Consequently, it seems difficult to design a study on bilateral oophorectomy during vaginal hysterectomy without accounting for this potential bias. Indeed, the authors should decide whether patients who had associated disorders diagnosed at surgery would be excluded or not. If these patients were to be excluded, it would be essential to decide how the pelvis is assessed. In fact, the Evaluate study clearly confirmed the diagnostic advantage of the laparoscopic approach, because additional pelvic disease was found 3 times more often in patients who had laparoscopic surgery than in patients who had vaginal surgery. More than 15 years after the first case reported by Reich,4Reich H. De Caprio J. McGlynn F. Laparoscopic hysterectomy.Gynecol Surg. 1989; 5: 213-216Crossref Scopus (757) Google Scholar the role of laparoscopy in hysterectomy is still highly controversial, and unfortunately the paper by Agostini et al adds very little if anything to the debate. ReplyAmerican Journal of Obstetrics & GynecologyVol. 196Issue 1PreviewWe read with concern the issues raised by Canis et al1 regarding the value of our publication. First of all, we kindly invite them to re-examine the study published by Garry et al.2 This series does not concern a unique and homogeneous core of laparoscopic hysterectomy procedures. It includes a wide range of interventions such as laparoscopic hysteroscopy, laparoscopic-assisted vaginal hysterectomy, laparoscopic supracervical hysterectomy, and total laparoscopic hysterectomy. Each of these procedures may have its own specific range of complications. Full-Text PDF" @default.
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• W3148548719 date "2007-01-01" @default.
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• W3148548719 title "Value of laparoscopic assistance for vaginal hysterectomy with prophylactic bilateral oophorectomy" @default.
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• W3148548719 doi "https://doi.org/10.1016/j.ajog.2006.05.035" @default.
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