Bladder Injury after LAVH: A Prospective, Randomized Comparison of Vaginal and Laparoscopic Approaches to Colpotomy during LAVH

Study Objective. To compare results of a vaginal approach to colpotomy (type IA) and laparoscopic-assisted abdominal colpotomy (type ID) in performing a laparoscopic-assisted vaginal hysterectomy (LAVH). Design. Prospective, randomized study (Canadian Task Force classification I). Setting. Tertiary teaching hospital. Patients. Five hundred forty-one women, 274 in group 1 (type 1D) and 267 in group 2 (type 1A). Intervention. LAVH with follow-up for 3 months to 5 years. Measurements and Main Results. There were no statistically significant differences in age, preoperative and postoperative hemoglobin values, or postoperative hospital stay between groups. Operating time and estimated blood loss were significantly reduced in group 2 (p <0.001 and <0.001, respectively). Women in group 1 had nine urinary tract injuries (3.28%), including eight cases of intraoperative bladder injury (2.91%) and one vesicovaginal fistula (0.36%), but no ureteral injury. The bladder injury rate in group 2 was 0.37%, which was significantly lower (p = 0.038). There were no significant differences in ureteral or bowel injuries, pelvic hematomas, or pelvic abscesses. Conclusion. LAVH type IA achieved better results than type ID in preventing bladder injury.