Outpatient Laparoscopic Hysterectomy with Discharge in 4 to 6 Hours

In this ongoing prospective "pilot" study we established stringent criteria for outpatient laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy (LAVH), Burch, and vaginal hysterectomy (VH) with discharge the same afternoon. The preliminary results include seven patients, and since September 1993 four patients with laparoscopic hysterectomies were discharged in an average time of 4 hours and 27 minutes. These were performed using CO2 laser technology, including uterine arteries, cardinal ligaments, bladder flap, and anterior and posterior vaginal entry laparoscopically. The laser/fulguration technique obviated any minor concerns about staple line integrity. Also one LAVH (CO2 laser) patient was discharged in 3 hours and 50 minutes. One VH patient was discharged in five hours, and one patient with a laparoscopic Burch colposuspension was discharged in 5 hours and 30 minutes. A strict postoperative protocol was followed, including a hematocrit (hct) at four hours. Brief home nurse visits were made at 2000 and 2200, plus one home visit at 0800 the day after surgery (hct repeated). The average hct drop was approximately three points. There were no complications and all patients are very satisfied with their decision. "Short stay" procedures warrant further study.