Laparoscopic Minilaparotomy Hysterectomy
Authors: Wood Carl , Maheri Peter 
Published: February 2008

EDITORIAL COMMENT: Where will it all end? What percentage of females have organic disease or symptoms of pain, abnormal bleeding or prolapse that surely merit hysterectomy by any of the available methods and/or routes, or the alternative procedures of endometrial removal or control by hormones administered locally or by other routes? Cost‐effectiveness considerations have intensified the debate but early discharge from hospital and even early return to work are not the ultimate arbiters of successful surgery. There are the problems of late convalescence and complications, both physical and psychological. Many recent changes in practice in obstetrics and gynaecology are driven not by humanitarian considerations but rather the need for hospitals to survive with harsh budget cuts that can be met only by reduction in staff numbers (their major cost) which translates itself to fewer beds, closed wards, faster throughput to maintain fee‐for‐service income, and thus, inevitably less time in hospital after surgery or confinement.

These problems were well reviewed by Clinch when reporting his experience in Dublin hospitals where length of hospital stay after vaginal hysterectomy was reduced 50% from a mean of 6.6‐7.0 days in 1986‐1987 to 3.4 in 1992A. Others have responded that prospective studies are required to assess the long and short‐term impact of early discharge on both patient well‐being and financial cost following hysterectomyB. We accepted this paper for publication because the authors have explored and carefully published their findings on different methods of facilitating removal of the uterus vaginallyC, D, or of controlling endometrial disease and avoiding the need for hysterectomyE. It is interesting for readers to reflect that in recent years gynaecologists in Melbourne have changed from an abdominal‐vaginal hysterectomy ratio of 6:IF to 1:8G mainly by laparoscopic techniques to facilitate removal of the uterus vaginally. The present technique has gone full circle and shows how minilaparotomy can assist the laparoscopist to remove the uterus vaginally, after introducing his finger into the peritoneal cavity to allow the division of pedicles in the fashion usually performed during abdominal hysterectomy. Why not merely enlarge the minilaparotomy incision a few more centimetres, perform all of the surgery abdominally, and send the women home a day or two later, with outpatient removal of the skin sutures at the usual time? All said and done women are often miserable in hospital and need to return home to have a good rest and favourite food after coping with the hordes of visitors that arrive at almost any hour.

A. Clinch J. Length of hospital stay after vaginal hysterectomy. Br J Obstet Gynaecol 1994; 101: 253‐254.

B. Cresswell JL, Iqbal PK. Letter to the editor. Br J Obstet Gynaecol 1994; 101: 1025.

C. Wood C, Maher P, Hill P, Selwood T. Hysterectomy: A Time of Change. Med J Aust 1992; 157: 651‐653.

D. Wood C, Maher P, Hill D. Replacement of Abdominal Hysterectomy by the Laparovaginal Technique ‐ Its Success and Limitations. Aust NZ J Obstet Gynaecol 1994; 34: 571‐574.

E. Maher P, Hill D. Transcervical Endometrial Resection for Abnormal Uterine Bleeding ‐ Report of 100 cases and Review of the Literature. Aust NZ J Obstet Gynaecol 1990; 30: 357‐360.

F. Beischer NA, Sheedy MT. Sixth Clinical Report Mercy Hospital for Women 1987‐1989, p 145.

G. Calandra C. Laparoscopically‐assisted Vaginal Hysterectomy. Aust NZ J Obstet Gynaecol 1995; 35:78‐82.