Feasibility and safety of total laparoscopic hysterectomy (TLH) using the Hohl instrument in nonobese and obese women

Abstract

The aim of the present study was to evaluate the feasibility, safety, and complication rates of total laparoscopic hysterectomy (TLH) using the Hohl instrument in nonobese and obese women. A prospective controlled trail (Canadian Task Force classification II-1) was conducted at the Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen-Nuremberg, Germany. Two hundred and fifty-seven women underwent total laparoscopic hysterectomy using the Hohl instrument between January 2006 and May 2008. The laparoscopic approach was used when the patient had undergone previous pelvic abdominal operation and/or had a reduced vaginal capacity. Women were classified according to their body mass index (BMI), with a cutoff point of 30 kg/m(2). Total laparoscopic hysterectomy was performed using the Hohl instrument. One ureteral injury, one bladder injury, one vaginal injury, and one injury to the epigastric vessels occurred. Blood transfusion was necessary in one patient. One conversion to abdominal hysterectomy was performed in a woman with a uterus weighing 893 g. In the postoperative phase, suture dehiscence at the vaginal closure occurred in three patients, one patient had bladder infection, one woman developed unexplained fever, and a hematoma without infection at the vaginal vault occurred in one woman. All complications occurred in women with BMI < 30 kg/m(2). TLH using the Hohl instrument is feasible and safe in nonobese and obese patients.