Percutaneous Versus Laparoscopic Hysterectomy: A Prospective Comparison

Abstract

Study Objective To evaluate the feasibility of percutaneous approach, we prospectively compared our percutaneous hysterectomy (PPS-H) experience with a series of laparoscopic hysterectomies (LPS-H). Design Multicentric comparative prospective study. Setting Fondazione Policlinico Universitario A. Gemelli IRCCS, in Rome, a tertiary health-care center, was the coordinator center. Patients or Participants From May 2015 to September 2017, 160 patients affected by benign and malignant gynecological conditions were considered eligible for minimally invasive surgery (MIS). Eightypatients received PSS-Hand 80 LPS-H. In each group, 30 cases of low/intermediate risk endometrial cancer were enrolled. Interventions hysterectomy ± bilateral salpingo-oophorectomy with or without lymph nodal staging. Measurements and Main Results No statistically significant differences were noted in baseline characteristics or operative time (OT) between the two groups. We observed significant differences in estimated blood loss (EBL): median of 50 cc (PSS-H) and 100 cc (LPS-H), P= 0.0001. In LPS-H, we reported 4 (5.0%) intraoperative complications and one (1.3%) in PSS-H. One post-operative fever for each group was reported. Thirty-day complications were 4 (5%) in PSS-H and 11 (13.8%) in LHS-H, P = 0.058. No significative differences were found in VAS(Visual Analogue Scale) score, despite a relevant disparity in cosmetic outcome (P=0.0001). For oncological cases, the two techniques had comparable intraoperative outcomes and oncological accuracy. Five (16.7%) 30-days complications occurred (P=0.052) in LPS-H. No significant differences were noted in FIGO stage or post-operative management. All patients enrolled were alive at the time of follow-up. Conclusion PSS-H is comparable to the LPS-H for intra and peri-operative outcomes and post-operative pain. Our study indicates PSS-H seems to be superior to LPS-H in cosmetic outcomes and patient satisfaction. We conclude PSS-H is a promising alternative in ultra-MIS in Gynecology.