Laparoscopic Versus Abdominal or Vaginal Hysterectomy for Large Uterus

Abstract

Study Objective: To evaluate the results of total laparoscopic hysterectomy (TLH) compared to vaginal and abdominal techniques.Design: Retrospective analysis of 256 cases (extracted from the total number of 2158 cases) of total laparoscopic, 51 vaginal and 44 laparotomic hysterectomies performed for uterine myoma.Setting: Dept. Operative Gynecology of the Research Centre for Obst., Gyn., & Perinatology, Dept. of Reproductive Medicine and Surgery, Moscow State Univercity of Medicine and Dentistry.Patients: The patients were aged 45.8±3.4 yrs. Uterine size varied from 12 to 24 weeks in the groups of laparoscopic and laparotomic hysterectomies, average uterine weight was 674.4±93.3 and 669.3±83.3 g respectively. In the group of vaginal surgery uterine size varied from 12 to 17 weeks with the weight of 324.4±76.1.Intervention: Total laparoscopic, vaginal and laparotomic hysterectomies.Measurements and Main Results: All laparoscopic procedures were done with no convertions to laparotomy. Blood loss in laparoscopic procedures was 112.4±27.1, in laparotomic - 275.4±96.6, in vaginal – 253.3±45.6 ml; in the last two groups the blood loss correlated with operating time. Average duration of laparoscopic procedures was significantly lower than of other two practiced techniques (79.7±8.6 versus 112.1±14.5 and 50.6±6.2, respectively). Morcellation and removal of large myomatous uteri in laparoscopic procedures lasted from 3 to 50 min (average 50.6±6.6 min); in 18 patients (7.0%) this step consumed more time than hysterectomy itself. No intra- or postoperative complications occurred in the group of laparoscopic surgery, while after vaginal surgery the complications rate was 3.2%, and after laparotomic – 9.1%.Conclusion: Total laparoscopic hysterectomy presents a real alternative to laparotomic procedure even in cases of very large uteri. Under certain anatomic conditions (wide pubic arc, capacious vagina, mobile uterus) vaginal hysterectomy for large myomatous uterus is also possible. Study Objective: To evaluate the results of total laparoscopic hysterectomy (TLH) compared to vaginal and abdominal techniques. Design: Retrospective analysis of 256 cases (extracted from the total number of 2158 cases) of total laparoscopic, 51 vaginal and 44 laparotomic hysterectomies performed for uterine myoma. Setting: Dept. Operative Gynecology of the Research Centre for Obst., Gyn., & Perinatology, Dept. of Reproductive Medicine and Surgery, Moscow State Univercity of Medicine and Dentistry. Patients: The patients were aged 45.8±3.4 yrs. Uterine size varied from 12 to 24 weeks in the groups of laparoscopic and laparotomic hysterectomies, average uterine weight was 674.4±93.3 and 669.3±83.3 g respectively. In the group of vaginal surgery uterine size varied from 12 to 17 weeks with the weight of 324.4±76.1. Intervention: Total laparoscopic, vaginal and laparotomic hysterectomies. Measurements and Main Results: All laparoscopic procedures were done with no convertions to laparotomy. Blood loss in laparoscopic procedures was 112.4±27.1, in laparotomic - 275.4±96.6, in vaginal – 253.3±45.6 ml; in the last two groups the blood loss correlated with operating time. Average duration of laparoscopic procedures was significantly lower than of other two practiced techniques (79.7±8.6 versus 112.1±14.5 and 50.6±6.2, respectively). Morcellation and removal of large myomatous uteri in laparoscopic procedures lasted from 3 to 50 min (average 50.6±6.6 min); in 18 patients (7.0%) this step consumed more time than hysterectomy itself. No intra- or postoperative complications occurred in the group of laparoscopic surgery, while after vaginal surgery the complications rate was 3.2%, and after laparotomic – 9.1%. Conclusion: Total laparoscopic hysterectomy presents a real alternative to laparotomic procedure even in cases of very large uteri. Under certain anatomic conditions (wide pubic arc, capacious vagina, mobile uterus) vaginal hysterectomy for large myomatous uterus is also possible.