After recruiting the patients, they were informed necessary about the study and written consent was obtained. Women with benign gynecological conditions who required hysterectomy and where vaginal hysterectomy was not an option were recruited for the study. All these women were explained in detail about the advantages (abdominal hysterectomy: less operating time, regional anaesthesia, less cost; LAVH: less pain, cosmetic benefit) and disadvantages (abdominal hysterectomy: bigger incision, more postoperative pain; LAVH: chance of conversion to open method, only option of general anaesthesia, more time) of both the procedures with the help of a pre-prepared information leaflet which was based on the literature review. Patients were then allowed to choose from the two methods.

A written consent was obtained from all the participants. All patients were given an oral gut lavage solution containing polyethylene glycol, sodium chloride, potassium chloride, and sodium bicarbonate, 1.5 liters ingested over 2-3 hours. Proctoclysis enema was administered the night before and also in the morning of the day of surgery. Patients were kept nil per oral for 12 hours before the surgery. Antiseptic vaginal douche was done preoperatively. All patients were subjected to prophylactic intravenous antibiotic half an hour before surgery and then eighth hourly in the postoperative period for 48 hours (amoxicillin 1000mg + clavulanic acid 200mg). Additional antibiotic was added if the same was deemed necessary due to any postoperative infection. General anesthesia was administered to all patients.

All surgeries were performed by a set of gynecologists with more or less same level of surgical experience and expertise. Abdominal hysterectomy was performed by the extrafascial technique and the vaginal cuff was sutured with interrupted sutures. LAVH was performed using video monitoring equipment. A 10mm laparoscope with a Storz endovision camera was inserted in a subumbilical position. Three more 5mm entry ports were created, one on each right and left spinoumbilical line and one on midline suprapubic region 3cm above the symphysis pubis. Opening of bladder flap was done laparoscopically whereas bladder dissection was done during the vaginal phase of hysterectomy. Vaginal phase of hysterectomy was commenced with an anterior circumferential incision of the vagina.

At the end after closing the vaginal cuff, a pneumoperitoneum was recreated to confirm hemostasis. A decision to convert a LAVH to an abdominal hysterectomy was readily made if difficulties were encountered. Following both, Foleys urinary catheter was left in situ and was removed after 24 hours or later depending Entinostat upon the individual case. In LAVH, a vaginal pack was left in situ which was also removed 24 hours later. Postoperatively, all patients were prescribed an identical regimen of analgesia.