BMJ  2004;328 (17 January), doi:10.1136/bmj.328.7432.0

Laparoscopic hysterectomy: less pain, more complications, similar costs

Laparoscopic hysterectomy carries a shorter in hospital stay and results in less pain six weeks after the operation, but it has more major complications than abdominal hysterectomy. Analysing data from the eVALuate study, a large multicentre trial involving 1346 women, Garry and colleagues (p 129) found a higher rate of major complications and longer operative time in the laparoscopic group than with the conventional abdominal approach. At six weeks patients who had laparoscopy had less pain and better quality of life.

The cost effectiveness of the laparoscopic methods are similar to conventional vaginal and abdominal hysterectomy. Sculpher and colleagues (p 134) compared data from the eVALuate trial and found that the laparoscopic method increases costs and has a small effect on quality adjusted life years after a year. Laparoscopic vaginal hysterectomy was not cost effective, and when the abdominal approach was used, costs of laparoscopy were close to the limit of £30 000 per QALY the NHS is willing to pay.

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