A randomised comparison and economic evaluation of laparoscopic-assisted hysterectomy and abdominal hysterectomy



The studies by Ottosen et al.1 and Mary Ann Lumsden attempt to answer the wrong question. The only advantage of laparoscopic-assisted vaginal hysterectomy is that it facilitates the ligation and division of the infundibulopelvic ligaments, allowing the removal of the ovaries and fallopian tubes vaginally. It is a paradox that in younger women, where ovarian conservation is the rule, the ovaries are mobile and lie medially adjacent to the uterus, such that vaginal oophorectomy is relatively easy and safe; while in older women, where prophylactic oophorectomy is required, the ovaries are less mobile and lie laterally on the side wall of the pelvis, making vaginal oophorectomy difficult and dangerous. It is in older women that laparoscopic-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy has a great advantage. It is this procedure that should be compared with vaginal hysterectomy and bilateral salpingo-oophorectomy, and with abdominal hysterectomy and bilateral salpingo-oophorectomy.