Case Series Analysis: Biclamp® Total Laparoscopic Hysterectomy Versus Biclamp® Vaginal Hysterectomy – Is There a Clear Winner?

Abstract

Study Objective: To compare burgeoning techniques of hysterectomy, compare efficacy of and safety of Total Laparoscopic Hysterectomy (TLH) versus Vaginal Hysterectomy (VH) both approaches utilising ERBE Biclamp® technology. Design: A retrospective case series comparing operative profiles of 35 consecutive Biclamp® Total Laparoscopic Hysterectomies with 35 consecutive Biclamp® Vaginal Hysterectomies performed between 1/11/07 to 03/4/09. Setting: Antrim Area Hospital, Department of Gynaecology, Northern Ireland. Patients: 70 patients with varying indications for hysterectomy. Measurements and Main Results: Operative time, blood loss, complications and hospital stay were the primary outcomes of study. Mean operating time for the TLH group was 73 minutes (range 45-175 min) versus 83 minutes (range 50-120 min) for the VH series. Estimated blood loss was approximately 4 times less in the TLH group, average 56 ml versus 200ml in the VH series. Mean uterine size was 169 grams (range 62-575 grams) in the TLH group versus 118 grams in the vaginal hysterectomy series (range 48- 602 grams). A much shorter hospital stay was noted in the TLH series with an average of 34 hours, which approached 24 hours towards the end of the series. This compared to an average of 84 hours in the VH series. No major intra-operative complications were observed in either group. In the TLH series one patient developed a port site hernia and one experienced transient urinary retention. In the VH series 2 patients required blood transfusions and 2 urinary tract infections occurred. Conclusion: Considerably shorter hospital stay, operative time, blood loss and morbidity where noted in the total laparoscopic hysterectomy series compared with the vaginal hysterectomy series.