الفهرس 
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Abstract
Background: Hysterectomy is the second most common major surgical procedure performed on women after caesarean section. In India, the incidence of hysterectomy is 4-6% out of which 90% are performed for benign indications.
Aim of the work: The aim of this study was to compare intra- and post-operative morbidity associated with three different types of laparoscopic hysterectomy. Laparoscopic-Assisted Supracervical Hysterectomy (LASH) (group A), Laparoscopic-Assisted Vaginal Hysterectomy (LAVH) (group B) and Total Laparoscopic Hysterectomy (TLH) (group C).
Patients and methods: A total of 60 women scheduled to undergo a hysterectomy for benign disease were subdivided into 3 groups; 20 women for LASH, 20 women for LAVH and 20 women for TLH, all women included in this study provided informed consent. Patients were excluded from the study if they had contraindication to laparoscopy including medical condition that may be worsen pneumoperitoneum and the Trendelenburg position. Additionally, patients were excluded if they had a suspected or confirmed malignant disease or uterine size more than 16 week gestational uterus. All patients underwent the same standard preparation prior to surgery including investigation, D&C and antibiotic prophylaxis. All the operations were performed under general anesthesia with endotracheal intubation. All the operations were performed using vessel sealing machine ”Ligasure” version force triad by using Ligasure Atlas (10 mm) instrument and Ligasure V 5 mm instrument. Intra- and post-operative evaluations including the duration of the operation (from first incision to the last suture), uterine weight, frequency of intraoperative complication, and the difference between hemoglobin level prior to surgery and one day after surgery.
Results: Our study showed that group A (LASH) took the shortest operation time while group B (LAVH) took the longest operating time. As regard hemoglobin deficit that occurred after 24 hours of surgery, our study showed that group A (LASH) with least Hb deficit (1.41 gm/dl) while group C (TLH) with largest Hb deficit (1.6 gm/dl) but still the Hb deficit not significantly different. As regard transfusion of blood, no cases took blood in group A, while one case took blood in group B and one case in group C. As regard other complications, the bladder was injured during plunt dissection of the bladder flap in group C and this case was having history of one cesarean section 10 years ago.
Conclusion: Laparoscopic assisted supracervical hysterectomy, laparoscopic assisted vaginal hysterectomy and total laparoscopic hysterectomy. In our study, we do prospective comparative study among the 3 groups of patients and after statistical analysis we conclude that laparoscopic assisted supracervical hysterectomy is the best method of laparoscopic hysterectomy in patient who wishes to have the uterine cervix preserved, but these patients must be underwent an annual follow-up program by colposcopy. In our outpatient clinic to detect any changes in the cervical epithelium and manage it very early. LASH is considered the best method of laparoscopic hysterectomy due to least hospital stay, least blood loss, and least intraoperative and postoperative complication.