Total laparoscopic hysterectomy making easy – the technique and tools: a 8-year experience

Abstract

Introduction: Laparoscopic surgical techniques are being used increasingly more in gynecological practice and the introduction of modem laparoscopic instruments has allowed complex operations to be performed laparoscopically technique safely. The aim of this study to evaluate our surgical technique with regards to the success of total laparoscopic hysterectomy (TLH) for the removal of the uterus by analysing its intra-operative and post-operative outcomes and complications. Methods: A Retrospective observational study was carried out at Feni Pvt. Hospital (FPH), Feni and Chowmuhani General Hospital (CGH) Noakhali, Bangladesh based on TLH operations performed from January 2008 to December 2015. The Q-Colpotomizer system a very simple uterine manipulator device were used. The Pneumoperitoneum was maintained by sterile wet sponge vaginal pack. Results: Four thousands and ninty six women consented for TLH. Four thousands forty eight women (98.8.%) had successful TLH with twenty four mini-laparotomy and twenty-four laparotomy conversions (1.2% failure rate). Mean uterine size was 11 cm (5–20). Mean operating time was 93 min (25–207). Mean blood loss was 209 ml (50–520). One hundred sixty four patients (4%) required blood transfusion. Injuries include, bladder (4), ureterovaginal Fistula (04) and vaginal laceration (04). Post-operative complications include pyrexia (22), umbilical wound infection (8), urinary tract infection (72) and vault haematoma (4). Mean hospital stay was 2.3 days (1–7). Twelve patients (0.3%) were readamitted for – vaginal bleeding (3), vault haematoma (1), UTI (2), anxiety (2), and ureterovaginal fistulla (4). Twelve women (0.3.%) encountered major complications (laparotomy conversion, excessive bleeding requiring blood transfusion). Our mean operating time, mean estimated blood loss, mean hospital stay and readmission rate are comparable. Conclusion: Total laparoscopic hysterectomy can be carried out successfully with very simple equipments and adequate training is associated with low morbidity, few complications and a high success rate. Keywords: Laparoscopic hysterectomy; Intra-operative complication; Post-operative; Complications, Q-Colpotomizer systems