• John P Lenihan, Carol Kovanda, and Clare Cammarano.
• Tacoma Women's Specialists, PC, WA 98405, USA. jlenihan@tacomaobgyn.com
• Am. J. Obstet. Gynecol. 2004 Jun 1;190(6):1714-20; discussion 1720-2.

ObjectiveThe purpose of this study was to compare the cost-effectiveness of laparoscopic-assisted vaginal hysterectomy to traditional total abdominal hysterectomy and total vaginal hysterectomy with regard not only to direct hospital costs but also to indirect costs.Study DesignThis was a combined retrospective cohort study (Canadian Task Force classification II-2) that was conducted in a suburban private practice. The cases of 268 patients who underwent hysterectomies over a 27-month period were analyzed to include clinical outcomes, direct hospital costs, and indirect costs (time to return to normal function, time to return to work, and time away from work required by other family members).ResultsFor all patients, length of hospital stay and time of return to normal function were shorter for laparoscopic-assisted vaginal hysterectomy than for total abdominal hysterectomy and total vaginal hysterectomy. For working patients, time to return to work and time off for working family members were all significantly shorter after laparoscopic-assisted vaginal hysterectomy when compared with both total abdominal hysterectomy and total vaginal hysterectomy. Operating times were similar for total abdominal hysterectomy and laparoscopic-assisted vaginal hysterectomy, and complications were greater for total abdominal hysterectomy. In a comparison of all procedures, direct hospital costs were greatest for laparoscopic-assisted vaginal hysterectomy and least for total vaginal hysterectomy.ConclusionFor most patients, laparoscopic-assisted vaginal hysterectomy provides a minimally invasive way to accomplish a hysterectomy with a lower cost to employers (payers) on the basis of lost work hours.

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