Despite years of research, indications for LAVH remain elusive. (Expert Opinion).

ST. LOUIS -- If laparoscopically assisted vaginal hysterectomy is the ideal procedure for anyone, it's still not clear who those patients are, even after years of research and dozens of studies, Dr. Thomas G. Stovall said at the 11th International Pelvic Reconstructive and Vaginal Surgery Conference.

The idea of laparoscopically assisted vaginal hysterectomy (LAVH) is very appealing. Laparoscopic techniques can be used to ligate the infundibulopelvic ligaments or the uteroovarian ligaments, uterine arteries, and cardinal ligaments, which theoretically should make the vaginal approach easier and increase its utilization, said Dr. Stovall of the University of Tennessee, Memphis.

But in practice, it's not clear when laparoscopic assistance is truly necessary and when a straightforward vaginal hysterectomy--sparing the patient the added operative time and morbidity associated with laparoscopy--could be performed instead. The majority of available evidence on the topic is based on case series studies, and there is no consensus about the circumstances under which operative laparoscopy is helpful.

Using a laparoscope for diagnostic purposes before hysterectomy doesn't work either, he maintained. The problem is that in the majority of patients it's not possible to determine who is most likely to have adhesions or endometriosis based on history and examination alone. "You can get a general idea of who's at risk, but the majority of people will end up not having the disease" so it's simply not worth the added risks to routinely use laparoscopy for diagnostic purposes.

Among the seven indications for LAVH mentioned in the literature, chronic pelvic pain is one that may not even require hysterectomy he said. In three ...