Researchers at the University of Insubria (Varese, Italy) conducted a prospective, randomized trial in 82 patients to compare laparoscopic and vaginal hysterectomies. The patients were randomly assigned to one of the procedures; women with uterine volume exceeding 14 weeks of gestation, suspected malignancy, adnexal masses larger than 4 cm, or a history of chronic pelvic pain, endometriosis, or pelvic inflammatory disease were excluded from the study. The anesthesiologists used a strictly standardized protocol in all cases, and postoperative pain was measured using the visual analog scale (VAS) at 1, 3, 8, and 24 hours postoperatively. Intra- and post-operative outcomes were carefully recorded, including the need for postoperative rescue doses of analgesia.

The results showed that VAS scores were approximately twice as high in the vaginal hysterectomy group as in the laparoscopy group; 7 patients treated laparoscopically and 32 treated by the vaginal route required morphine. The median hospital stay was one day in the laparoscopy group and two days in the vaginal group. There was a 5-minute advantage in operative time with laparoscopic cohort, which was statistically but not clinically significant; other perioperative characteristics were comparable between the two groups. The study was published early online on June 4, 2010, in the American Journal of Obstetrics and Gynecology.

"Electrosurgical devices only during laparoscopy hysterectomy may partially account for the lower pain scores. Another possibility is the ‘vigorous downward traction on the uterus' during vaginal surgery,” concluded lead author Fabio Ghezzi, M.D., and colleagues of the department of obstetrics and gynecology. "Treatment choice must take into account the surgeon's skill with each procedure.”

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University of Insubria