Laparoscopic hysterectomy versus total abdominal hysterectomy: a comparative study

OBJECTIVE: The objective of this study was to compare the intraoperative and short-term postoperative complications of laparoscopic hysterectomy and total abdominal hysterectomy. STUDY DESIGN: Retrospective study of 167 women who had laparoscopic hysterectomy and 119 women who had total abdominal hysterectomy. For assessing the learning curve, the laparoscopic hysterectomies were further subdivided to the first 30 hysterectomies and the later hysterectomies. For data analysis Student's t-test, chi2-test and Fisher's exact test were used. RESULTS: There were no statistically significant differences between the two groups for age, body mass index, previous abdominal surgery, uterine weight, first postoperative day hemoglobin drop, blood transfusion and major or minor complications rate. Operation time was significantly longer for laparoscopic than abdominal hysterectomy (156+/-40 and 91.2+/-33 min, respectively; P<0.001) but the length of hospital stay was significantly shorter (3.9 and 6.55 days, respectively; P<0.001). The conversion rate of laparoscopic hysterectomy was 1.8% (three cases). CONCLUSIONS: Laparoscopic hysterectomy can be safely done even during the learning curve with a low and reasonable complication rate, and a shorter hospital stay but with longer operation time. As experience is gained the operation time, complication rate and hospital stay are decreased.     

Quality of life and surgical outcome after total laparoscopic hysterectomy versus total abdominal hysterectomy for benign disease: a randomized, controlled trial

STUDY OBJECTIVE: Minimally invasive surgery aims to achieve at least a similar clinical effectiveness with a quicker recovery than traditional open techniques. Although there have been numerous randomized clinical trials comparing laparoscopic hysterectomy with hysterectomy by laparotomy, only a few studies have compared quality of life after different types of hysterectomy. None of these studies evaluated total laparoscopic hysterectomy. In this paper, we report on a randomized comparison of quality of life after total laparoscopic versus total abdominal hysterectomy. DESIGN: Randomized, controlled trial (Canadian Task Force classification I). SETTING: Single-center teaching hospital in The Netherlands. PATIENTS: Patients scheduled for hysterectomy for a benign condition, in whom a vaginal hysterectomy was not possible and laparoscopic hysterectomy was feasible (mobile uterus not exceeding the size of 18 weeks' gestation). INTERVENTIONS: Abdominal versus laparoscopic hysterectomy. MEASUREMENTS AND MAIN RESULTS: Patients completed the Dutch version RAND-36 health survey preoperatively as well as at 5 time points in the first 12 weeks after surgery. The primary outcome of the study was quality of life as measured by the RAND-36. A linear mixed model was used for statistical analysis while accounting for baseline values. Secondary outcomes were hospital stay and complications. There were 88 patients eligible, of whom 59 gave consent for randomization. Twenty-seven women were allocated to the laparoscopic arm and 32 to the abdominal arm. We found a significant treatment effect favoring laparoscopic hysterectomy in the RAND-36 scale for vitality. Laparoscopic hysterectomy performed better on all other scales of the RAND-36, but these differences were not statistically significant. CONCLUSIONS: Laparoscopic hysterectomy results in more postoperative vitality when compared with abdominal hysterectomy. For this reason, all women with a benign condition requiring abdominal hysterectomy, in whom the laparoscopic approach is feasible, should have the chance to choose laparoscopic hysterectomy.     

Psychological wellbeing after laparoscopic and abdominal hysterectomy--a randomised controlled multicentre study

OBJECTIVE: To compare laparoscopic hysterectomy and abdominal total hysterectomy regarding influence on postoperative psychological wellbeing and surgical measures. DESIGN: A prospective, open, randomised multicentre trial. SETTING: Five hospitals in the South East of Sweden. POPULATION: Hundred and twenty-five women scheduled for hysterectomy for benign conditions were enrolled in the study, and 119 women completed the study. Fifty-six women were randomised to abdominal hysterectomy and 63 to laparoscopic hysterectomy. METHODS: Psychometric tests measuring general wellbeing, depression and anxiety preoperatively and 5 weeks and 6 months postoperatively. MAIN OUTCOME MEASURES: Effects of operating method on the psychological wellbeing postoperatively. Analysis of data regarding operating time, peroperative and postoperative complications, blood loss, hospital stay and recovery time. RESULTS: No significant differences in the scores were observed between the two groups in any of the four psychometric tests. Both the surgical methods were associated with a significantly higher degree of psychological wellbeing 5 weeks postoperatively compared with preoperatively. The operating time was significantly longer for the laparoscopic hysterectomy group, but the duration of the stay in hospital and sick-leave were significantly shorter for laparoscopic hysterectomy group compared with the abdominal hysterectomy group. CONCLUSIONS: General psychological wellbeing is equal after laparoscopic and abdominal hysterectomy within 6 months after the operation. The advantages of the laparoscopic hysterectomy are the shorter stay in hospital and shorter sick-leave, but these issues must be balanced by a longer duration of the operation.     

Laparoscopic supracervical hysterectomy vs. abdominal hysterectomy in a community hospital. A cost comparison.

OBJECTIVE: To evaluate the feasibility for an institution to offer laparoscopic supracervical hysterectomy as a cost-effective alternative to total abdominal hysterectomy (TAH) in a managed care environment. STUDY DESIGN: Retrospective study in which 138 consecutive laparoscopic supracervical hysterectomies performed between December 1992 and May 1996 were reviewed and compared to 354 consecutive TAHs performed during the same period. Operating time, use of operative room supplies, length of stay and actual total, fixed and variable costs of each case were calculated for the entire hospital stay and for each hospital cost center. Differences between costs were analyzed by ANCOVA using age, patient weight, specimen weight and number of operative procedures performed at the time of hysterectomy as covariants. RESULTS: The mean operative room time was significantly greater for laparoscopic supracervical hysterectomy than for TAH (167.4 [SD 51.2] vs. 103 minutes [30.3, P < .001]). In contrast, length of stay was significantly shorter for laparoscopic supracervical hysterectomy than for TAH (0.8 [SD 1.1] vs. 3.4 days [.9, P < .001]). The adjusted mean costs of both operative room time and supplies were significantly higher for laparoscopic supracervical hysterectomy than for TAH (P < .001). In contrast, the mean cost of length of stay for laparoscopic supracervical hysterectomy was significantly lower (P < .001). However, the adjusted mean total costs of the entire hospital stay were not significantly different: $2,716 for laparoscopic supracervical hysterectomy vs. $2,702 for TAH (F = .7, P = .8). The absence of significant differences between procedures resulted from our limited use of disposable supplies (no automated stapling device) and from shorter lengths of stay, which compensated well for the higher operative room costs of time and supplies incurred with laparoscopic supracervical hysterectomy. CONCLUSION: Laparoscopic supracervical hysterectomy is, at least in the short term, a cost-effective alternative to TAH in a managed care environment.     

Gasless laparoscopic hysterectomy: a comparative study with total abdominal hysterectomy

AIM: To evaluate the short-term results of gasless laparoscopic hysterectomy (GLH) compared to total abdominal hysterectomy. METHODS: A comparative study of GLH using an abdominal wall-lifting device (n = 31) and total abdominal hysterectomy (TAH) (n = 31) was carried out between July 1999 and July 2001. RESULTS: One patient (3.2%) in the GLH group required conversion to TAH. The operative time was 168 +/- 38 min and 112 +/- 29 min (P < 0.001) for the GLH and TAH groups, respectively. Gasless laparoscopic hysterectomy cases had a shorter hospital stay and convalescent period (2.6 +/- 0.9 days vs 5.0 +/- 1.3 days, P < 0.001 and 8.0 +/- 3.0 days vs 15.8 +/- 2.4 days, P < 0.001, respectively). Postoperative meperidine use and estimated blood loss were lower for GLH (P < 0.001). Complications were comparable in the two groups. Hospital charges were 8.5% higher for GLH (P = 0.02). CONCLUSIONS: Gasless laparoscopic hysterectomy may be an alternative technique for hysterectomy which provides laparoscopic benefit with minimal increase in hospital charges.     

Total laparoscopic hysterectomy versus vaginal hysterectomy: a prospective randomized trial

AIM: The aim of the study was to compare the effects of total laparoscopic hysterectomy with those of vaginal hysterectomy. METHODS: We conducted a prospective randomised trial on 400 patients who agreed to be randomized to either laparoscopic total hysterectomy or vaginal hysterectomy. They were monitored for one year to evaluate the rate of major complications and the results on quality of life. RESULTS: Total laparoscopic hysterectomy was associated with a higher rate of major haemorrhages and ureteric injuries than vaginal hysterectomy (7% vs 2.5% and 2.5% vs 0%; P<0.05) only during the first year of study according to a normal learning-curve. It took longer to perform (85.9 min vs 46.6 min), but was less painful (visual analogue scale 5.3 vs 6.0; P<0.01) and there was a shorter stay in hospital after the operation (2.9 vs 3.3 days). Six weeks after the operation, total laparoscopic hysterectomy was associated with less pain and better quality of life than vaginal hysterectomy (SF-12). CONCLUSION: Total laparoscopic hysterectomy was associated with a significantly higher rate of major haemorrhages and ureteric injuries than vaginal hysterectomy only during the first year of study according to a normal learning-curve. It took longer to perform but was associated with less pain, quicker recovery, and better short term quality of life.     

Analysis of survival after laparoscopic-assisted vaginal hysterectomy compared with the conventional abdominal approach for early-stage endometrial carcinoma: a review of the literature

STUDY OBJECTIVE: To assess potential differences in perioperative features and survival between laparoscopic-assisted vaginal hysterectomy and conventional transabdominal hysterectomy in stage I endometrial cancer. DESIGN: Retrospective, nonrandomized clinical study (Canadian Task Force classification II-2). SETTING: Acute-care, teaching hospital. PATIENTS: A total of 370 patients undergoing hysterectomy and bilateral salpingo-oophorectomy with surgical staging for primary treatment for clinical stage I endometrial cancer from January 1995 through June 2001. INTERVENTION: Clinical outcomes and survival in patients treated with laparoscopic-assisted vaginal hysterectomy (n = 55) and hysterectomy using the conventional abdominal approach (n = 315) were compared. MEASUREMENTS AND MAIN RESULTS: Baseline characteristics and histopathologic variables were similar in both groups. A total of 91.4% of patients underwent pelvic lymphadenectomy and 49.7% paraaortic lymphadenectomy. The median follow-up was 38.1 months. Blood loss, blood transfusions required, and length of stay were significantly lower in the laparoscopic group, but surgical time was significantly longer. The mean number of pelvic and aortic nodes recovered was higher in the laparoscopic group (p < .001). Differences in overall and recurrence-free survival rates were not observed. CONCLUSION: Surgical staging of early-stage endometrial cancer by laparoscopic-assisted vaginal hysterectomy is feasible, with lower perioperative morbidity and shorter hospital stay compared with transabdominal hysterectomy. Prognosis and survival were not affected by the laparoscopic vaginal approach to hysterectomy.     

Laparoscopic supracervical hysterectomy versus laparoscopic total hysterectomy: a prospective randomized study

AIM: The aim of this study was to compare surgical complications and clinical outcomes after supracervical versus total laparoscopic hysterectomy for the control of abnormal uterine bleeding or symptomatic uterine leiomyomata. METHODS: We conducted a prospective randomized trial on 141 patients who had laparoscopic hysterectomy for symptomatic uterine leiomyomata, abnormal bleeding refractory to hormonal treatment, or both. Patients were randomly assigned to receive a supracervical or total laparoscopic hysterectomy. We compared surgical complications and clinical outcomes for 2 years after randomization. RESULTS: Seventy-one participants were assigned to supracervical laparoscopic hysterectomy (SLH) and 70 to total laparoscopic hysterectomy (TLH). Hysterectomy by either techniques led to statistically significant reductions in most symptoms, including pelvic pain or pressure, back pain and urinary incontinence. Patients assigned to SLH tended to have more hospital readmissions than those randomized to TLH. There were no statistically significant differences in the rate of complications, degree of symptoms improvement, or activity limitation. Participants weighing more than 100 kg at study entry were more than twice as likely to be readmitted to the hospital during the 2-year of follow-up (OR 2.48, 95% CI 0.11; 1.91, P=0.04). CONCLUSIONS: We did not observe statistically significant differences between SLH and TLH in surgical complications and clinical outcomes during the 2-years of follow-up.     

Total laparoscopic hysterectomy. Cost analysis]

BACKGROUND: Hysterectomy performed totally by laparoscopy is still one of the most advanced procedure in endoscopic gynecological surgery. The aim of this study has been to evaluate the cost and the hospital charges of total laparoscopic hysterectomy as compared with those for total abdominal and vaginal hysterectomy. METHODS: In particular, as far as laparoscopic technique is concerned, the cost of linear staplers have been analyzed as compared to disposable and non-disposable instruments for bipolar coagulation. RESULTS: After analysing the data, it has been found that the use of linear staplers involves very high median costs of Lire 2,932,304 ($ 1,650) versus the use of non-disposable instruments of Lire 936,488 ($ 526). The median total hospital charges was of Lire 6,014,448 ($ 3,380) for abdominal hysterectomy, of Lire 4,449,617 ($ 2,500) for vaginal hysterectomy and of Lire 4,078,000 ($ 2,291) for laparoscopic technique with non-disposable supplies. CONCLUSIONS: The results confirm, on the one hand, that bipolar coagulation is a reliable method of hemostasis, and on the other hand that laparoscopic surgery is a technique that can be recommended as an alternative to laparotomy for hysterectomy with unquestionable benefits both for patients and hospital.     

Laparoscopic-assisted Doderlein hysterectomy: retrospective analysis of 300 consecutive cases.

OBJECTIVE: To assess the clinical outcomes of the Doderlein laparoscopic-assisted hysterectomy. DESIGN: A retrospective study. SETTING: Women's Endoscopic Laser Foundation at South Cleveland Hospital, Middlesbrough and St James's University Hospital, Leeds. POPULATION: Three hundred consecutive women who had a laparoscopic-assisted Doderlein hysterectomy. METHODS: Patients were identified from the laparoscopic hysterectomy theatre log at both sites. Case notes were requested and examined. MAIN OUTCOME MEASURES: Operative time, uterine weight, associated pelvic pathology, blood loss, hospital stay, intra-operative and post-operative complications. RESULTS: The operations were performed by eight different surgeons, seven of whom were laparoscopic trainees. The mean operating time was 102 minutes (SD 30). Additional surgery including unilateral or bilateral salpingo-oophorectomy, was carried out in 247 patients (82%). The mean uterine weight was 140 g (SD 74). One hundred and thirty-two women (44%) had a normal pelvis at hysterectomy. The mean drop in haemoglobin and haematocrit was 1.46 g (SD 0.95) and 4.4% (SD 2.8), respectively. The overall complication rate was 18%, of which 6.2% were classed as major. The major complications included four cystotomies, five unscheduled laparotomies, seven post-operative blood transfusions, one pulmonary embolus and two re-operations (within six weeks). The mean hospital stay was three days. CONCLUSIONS: Laparoscopic-assisted Doderlein hysterectomy is an alternative to standard laparoscopic hysterectomy techniques. It has the advantage of being easy to learn and is associated with low complication rates, compared with other laparoscopic and traditional techniques for hysterectomy.     

Laparoscopic subtotal hysterectomy versus laparoscopic total hysterectomy: a decade of experience

At present, there are only few data on the surgical outcomes of laparoscopic hysterectomy (LH). Up till now, it has been unclear whether there is a difference in number of complications among the subcategories of laparoscopic total hysterectomy and laparoscopic subtotal hysterectomy (LSH). Therefore, we have performed a retrospective analysis to evaluate the peri- and postoperative outcomes in women undergoing LSH versus LH. This multi-centre retrospective cohort study (Canadian Task Force classification II-2) was conducted in multi-centres (two teaching hospitals and one university medical centre) in the Netherlands, all experienced in minimally invasive gynaecology. In a multi-centre retrospective cohort study we compared the long-term outcomes of laparoscopic subtotal hysterectomy and laparoscopic total hysterectomy (including laparoscopic assisted vaginal hysterectomy, laparoscopic hysterectomy and total laparoscopic hysterectomy). All laparoscopic hysterectomies from the last 10 years (January 1998 till December 2007) were included. Patient characteristics, intra- and postoperative complications, operating time and duration of hospital stay were recorded. The minimum follow-up was 6 months. A total of 390 cases of laparoscopic hysterectomies were included in the analysis: 192 laparoscopic subtotal hysterectomies and 198 laparoscopic total hysterectomies. Patient characteristics such as age and parity were equal in the groups. The overall number of short-term and long-term complications was comparable in both groups: 17% and 15%. Short-term complications (bleeding, fever) were 3% in the LSH group and 12% in the LH group. Long-term complications were (tubal prolapse and cervical stump reoperations) 15% in the LSH group and 3% in the LH group. Laparoscopic subtotal hysterectomy as compared with the different types of laparoscopic total hysterectomy is associated with more long-term postoperative complications, whereas laparoscopic total hysterectomy is associated with more short-term complications.     

Recovery from vaginal hysterectomy compared with laparoscopy-assisted vaginal hysterectomy: a prospective, randomized, multicenter study

OBJECTIVE: To evaluate short-term recovery of vaginal hysterectomy with those of laparoscopic assisted vaginal hysterectomy performed in a prospective, randomized multicentric study. STUDY DESIGN: Eighty patients referred for hysterectomy for benign pathology were randomized to either vaginal hysterectomy (40 patients) or laparoscopic assisted vaginal hysterectomy (40 patients). Inclusion criteria were uterine size larger than 280 g and one or more of the following: previous pelvic surgery, history of pelvic inflammatory disease, moderate or severe endometriosis, concomitant adnexal masses, and indication for adnexectomy. No upper limit of uterine size was set. All the laparoscopic and the vaginal hysterectomies were done under endotracheal general anesthesia. RESULTS: There was no statistically significant difference in terms of patient's age, parity, postmenopausal state, indication for surgery and mean uterine weight between the 2 groups. Laparoconversion was performed in three women in the laparoscopic group. Operative time was significantly shorter in the vaginal versus the laparoscopic groups 108+/-35 and 160+/-50 respectively (p<0.001). The use of paracetamol, non steroidal anti-inflammatory drugs, and opioid during hospitalization were similar in the 2 groups. There was no difference in the 1st day hemoglobin level drop, time of passing gas and stool, or hospital stay between the 2 groups. CONCLUSION: In contrast with earlier reports, there was no difference in short-term recovery between patients undergoing vaginal or laparoscopic hysterectomy. No advantage was found performing laparoscopic assisted vaginal hysterectomy in comparison with the standard vaginal hysterectomy.     

Comparison of total laparoscopic and abdominal radical hysterectomy for patients with early-stage cervical cancer

OBJECTIVE: To compare intraoperative, pathologic, and postoperative outcomes of total laparoscopic radical hysterectomy with abdominal radical hysterectomy and pelvic lymphadenectomy for women with early-stage cervical cancer. METHODS: We reviewed all patients who underwent total laparoscopic radical hysterectomy or abdominal radical hysterectomy and pelvic lymphadenectomy between 2004 and 2006. RESULTS: Fifty-four patients underwent abdominal radical hysterectomy, and 35 underwent total laparoscopic radical hysterectomy. Mean age was 41.8 years, and mean body mass index 28.1. There was no difference in demographic or tumor factors between the two groups. Mean estimated blood loss was 548 mL with abdominal radical hysterectomy compared with 319 mL with total laparoscopic radical hysterectomy (P=.009), and 15% of patients who underwent abdominal radical hysterectomy required a blood transfusion compared with 11% who underwent total laparoscopic radical hysterectomy (P=.62). Mean operative time was 307 minutes for abdominal radical hysterectomy compared with 344 minutes for total laparoscopic radical hysterectomy (P=.03). On pathologic examination, there was no significant difference in the amount of parametrial tissue, vaginal cuff, or negative margins obtained. A mean 19 pelvic nodes were obtained during abdominal radical hysterectomy compared with 14 during total laparoscopic radical hysterectomy (P=.001). The median duration of hospital stay was significantly shorter for total laparoscopic radical hysterectomy (2.0 compared with 5.0 days, P<.001). For abdominal radical hysterectomy, 53% of patients experienced postoperative infectious morbidity compared with 18% for total laparoscopic radical hysterectomy (P=.001). There was no difference in postoperative noninfectious morbidity. There was no difference in return of urinary function. CONCLUSION: Total laparoscopic radical hysterectomy reduces operative blood loss, postoperative infectious morbidity, and postoperative length of stay without sacrificing the size of radical hysterectomy specimen margins; however, total laparoscopic radical hysterectomy is associated with increased operative time.     

Pilot study assessing robotic laparoscopic hysterectomy and patient outcomes

STUDY OBJECTIVE: To examine the operative variables and complications associated with robotic-assisted total laparoscopic hysterectomy. DESIGN: Canadian Task Force classification II-1. SETTING: Gynecology service affiliated with a major cancer center in Southern California. PATIENTS: Twenty women with a benign gynecologic condition. INTERVENTION: Robotic-assisted total laparoscopic hysterectomy. Patient status was evaluated in terms of operative morbidity, length of surgery, anesthesia time, estimated blood loss, and hospital stay. MEASUREMENTS AND MAIN RESULTS: Mean operative time was 3.2 hours, and anesthesia time was 4 hours. Mean estimated blood loss was 81 mL, and patient postoperative hospital stay was 2 days. The complication rate in this study was low. The surgical procedure was converted to a laparotomy and abdominal hysterectomy in two patients because of poor visualization during robotic-assisted surgery. CONCLUSIONS: While the number of patients and nonrandomized nature of this single-institution experience are insufficient to draw any definitive conclusions regarding potential treatment efficacy, the patient postoperative stay and low complication rates suggest that this procedure is feasible and promising. Additional study comparing the efficacy and cost of robotic laparoscopic hysterectomy with standard laparoscopic hysterectomy with a larger patient population is warranted.     

No difference in length of hospital stay between laparoscopic and abdominal supravaginal hysterectomy--a preliminary study

BACKGROUND: Although a number of well-designed studies have concluded that laparoscopic hysterectomy is associated with less postoperative pain, reduced hospital stay, and shorter periods of sick leave, thus far, studies on the perioperative and postoperative outcomes of laparoscopic supravaginal hysterectomy (LSH) versus abdominal supravaginal hysterectomy (ASH) are lacking. By applying multimodal intervention program for the postoperative care of patients, the primary aim of the current study was to compare length of hospital stay, time to convalescence, and long-term patient satisfaction between LSH and ASH. METHOD: The study was conducted at the departments of Obstetrics and Gynecology, Skellefte? Hospital and Lycksele Hospital. Forty-seven consecutive women scheduled for supravaginal hysterectomy were randomly assigned to LSH or ASH. Perioperative and postoperative parameters were compared between the two groups. RESULTS: The length of the postoperative hospital stay did not differ between patients undergoing LSH and ASH, but the number of disability days was greater in the ASH group. The operating time was significantly longer in the LSH group compared with the ASH group, whereas the estimated perioperative bleeding was greater in the ASH group. At the 6-month follow-up, 87.0% of patients in the ASH group and 91.3% in the LSH group were satisfied or very satisfied with the overall result of the surgical procedure. CONCLUSION: The present study has indicated that by applying a multimodal intervention program for the postoperative care of patients undergoing supravaginal hysterectomy, the surgical procedure per se is of less importance than generally considered for the length of postoperative hospital stay and long-term patient satisfaction.     

Factors associated with increased charges for hysterectomy

OBJECTIVE: To evaluate factors associated with increased hospital charges for hysterectomy with specific attention to differences based on surgical approach. METHODS: We performed a retrospective cohort study of 686 patients who underwent hysterectomy between January 1997 and September 1997 using medical chart review and hospital financial information. Demographic information, surgical approach (abdominal, vaginal, or laparoscopic), and surgical and postoperative factors were extracted from the medical record. Hospital charges were obtained from the hospital billing database. Relationships between charges and various clinical and demographic variables were examined using chi(2), Fisher exact test, t tests, or analysis of variance, where appropriate. Logistic regression was used to estimate odds ratios while controlling for important confounding variables. RESULTS: In our logistic regression model, blood loss greater than 1,000 mL (odds ratio [OR] 11.8, 95% confidence interval [CI] 4.2-33.2) and operative time 105 minutes or more (OR 14.2, CI 5.8-34.5) were strongly associated with higher charges for hysterectomy. Other factors associated with higher charges included: postoperative fever (OR 2.2, CI 1.1-4.5), increasing length of hospitalization (OR 5.3, CI 3.7-7.7), the use of prophylactic antibiotics (OR 3.0, CI 1.3-6.6), and the laparoscopic surgical approach compared with vaginal hysterectomy (OR 2.7, CI 1.0-7.0). CONCLUSION: Surgical factors such as operative time and blood loss were strongly associated with increased hospital charges for hysterectomy.     

Challenges of laparoscopic hysterectomy: a 10-year experience in UK hospitals

This retrospective study was conducted on cases of laparoscopic hysterectomy performed over the duration of 10 years in two UK hospitals by the same surgeon. The aim was to evaluate the outcome and outline the factors which had an influence on the results. The study involved 270 cases of laparoscopic hysterectomy performed between 1993 and 2004. The majority of cases (257) were completed laparoscopically; 13 cases were converted to conventional abdominal hysterectomy for various reasons. Most of the patients had either total laparoscopic hysterectomy (141 cases) or laparoscopic hysterectomy (103 cases). Laparoscopic-assisted vaginal hysterectomy was performed in 13 cases only. The patients were selected according to certain criteria to optimise the outcome. The total complication rate was towards the lower limit reported by previous studies. The return to theatre rate, conversion to laparotomy rate and duration of hospital stay were comparable to the best results obtained before. The current study showed that good outcome could be achieved by proper selection of cases, appropriate indication and good surgical skills.     

Comparison of two procedures for laparovaginal hysterectomy: a randomized trial

OBJECTIVE: To compare peroperative parameters of two variants of a laparovaginal hysterectomy in surgical management of gynecological conditions. METHODS: A prospective randomized study of 70 laparovaginal hysterectomies performed by the same two surgeons for disease of female pelvic organs. The following criteria were studied: indication for surgery, previous surgery, duration of the procedure, recovery, hospital stay, blood loss, tissue damage markers, hysterectomy proportions and complication incidence. Statistical analysis was performed using the non-parametric chi(2)-test and non-parametric Fischer's exact probability test when appropriate, with a level of significance P=0.05. RESULTS: Totals of 38 (54.3%) laparoscopy-assisted vaginal and 31 (45.7%) vaginally assisted laparoscopic hysterectomies were performed for fibroma as the main indication. Conversion to laparotomy was applied in only one patient. The VALH group (P=0.01) showed both fewer procedures and shorter hospital stay with insignificant blood loss. CONCLUSION: The two variants of a laparovaginal hysterectomy appear to be safe and appropriate, effective procedures for women with gynecological conditions. Furthermore, vaginally assisted laparoscopic hysterectomy has been shown to be superior to laparoscopy-assisted vaginal hysterectomy in terms of shorter operating time and greater palliative effect upon the complex of uterosacral ligaments. Laparoscopic surgery can alter the relationship between vaginal and abdominal hysterectomy.     

Adnexal torsion after laparoscopic hysterectomy: description of seven cases

STUDY OBJECTIVE: To discover the prevalence of adnexal torsion after laparoscopic hysterectomy. DESIGN: Retrospective analysis (Canadian Task Force classification II-3). SETTING: A tertiary referral hospital. PATIENTS: One thousand thirty-three women underwent laparoscopic hysterectomies between the years 1995 and 2002. The mean age (+/- SD) of the women at the time of hysterectomy was 43.87 +/- 4.28 years. Intervention. Laparoscopic hysterectomy in which at least one adnexa was left intact. MEASUREMENTS AND MAIN RESULTS: The files of all women with adnexal torsion diagnosed by laparoscopy from 1995 to 2003 were retrospectively reviewed. In seven women, adnexal torsion occurred after laparoscopic hysterectomy. Torsion occurred 2.64 (+/- 1.79) years (mean +/- SD) after hysterectomy. Torsion was treated by laparoscopy in all of the women; either oophorectomy or detorsion and ovariopexy was performed. We calculated the prevalence of this complication to be 7.91/1000. CONCLUSION: Adnexal torsion can occur after laparoscopic hysterectomy.     

Disparities in Use of Laparoscopic Hysterectomies: A Nationwide Analysis

Study ObjectiveTo determine patient and hospital characteristics that were associated with undergoing laparoscopic hysterectomy compared with abdominal hysterectomy.DesignCanadian Task Force Classification II-3.MethodsIn this retrospective cohort study, we analyzed the 2010 Healthcare Cost and Utilization Project Nationwide Inpatient Sample database. All women who underwent laparoscopic or abdominal hysterectomy for either menorrhagia or leiomyoma were included based on International Classification of Diseases, Ninth Revision coding. A linear model with binomial distribution and logit link function was used to determine patient and hospital characteristics associated with hysterectomy approach.Main ResultsA total of 32 436 patients were included in this study. Of these, 32% patients underwent laparoscopic hysterectomies, and 67% underwent abdominal hysterectomies. With regard to patient characteristics, women younger than 35 years old were more likely to undergo laparoscopic hysterectomy when compared with each of the other age categories (p < .001). White women were more likely to undergo laparoscopic hysterectomy than black women, Hispanic women, or women classified as “other” races (p < .001 for all comparisons). With regard to median income, patients from the lowest national quartile were less likely to undergo laparoscopic hysterectomy when compared with each of the other 3 national quartiles for income (p = .01, p < .001, p = .001, respectively). Payment by private insurance was associated with laparoscopic hysterectomy when compared with payment by Medicare or payment by insurance category “other” (p < .001 for both). With regard to hospital characteristics, hospitals in the Northeast were more likely to have laparoscopic hysterectomies than hospitals in the Midwest or South (p < .001 for both comparisons); urban hospitals were more likely than rural hospitals (p < .001); teaching hospitals were more likely than nonteaching hospitals (p < .001); and government-owned hospitals were less likely than private, nonprofit or private, investor owned (p < .001 for both comparisons).ConclusionsDespite the increased popularity of and training in laparoscopic hysterectomies, there remains an obvious disparity in its delivery with regard to patient and hospital characteristics. Further investigation is needed on the etiology of this disparity and interventions that may alleviate it.