Outcomes Of Total Laparoscopic Hysterectomy Research Articles

Total Laparoscopic Hysterectomy Outcomes for Large Uterus (>14Weeks) Due to Large and Multiple Fibroids

Objective: Total laparoscopic hysterectomy (TLH) seems to be the best surgical route for most cases. However, the technical difficulties, while removing a large uterus due to huge fibroids should be noted. The aim of this study was to assess the effect of large uterine size (>14 weeks) due to large fibroids on the outcome of TLH. Material and Methods: A total of 234 TLH cases were included in the study. The study group consisted of the patients with clinical size >14 gestational weeks uterus (n=99). The control group consisted of patients with smaller uterine size and operated with benign indications (n=135). The groups were comparable regarding body mass index, comorbidities, and previous abdominal surgery. Results: The mean duration of operation, estimated blood loss and the rates of complications were similar between the groups. The rate of conversion to laparotomy did not show a statistically significant difference between the groups. There were five conversions in the study group due to excessive bleeding (n=2), inability to mobilize the uterus (n=2), and intestinal injury (n=1). The two conversions in the control group were also due to excessive bleeding. Conclusion: Total laparoscopic hysterectomy for large uterine size >14 weeks size due to large fibroids seems to be a safe and successful surgical approach.

Total laparoscopic hysterectomy for benign disease: outcomes and literature analysis

ObjectiveTo analyze surgical outcomes of total laparoscopic hysterectomy (TLH) for benign disease.MethodsRetrospective analysis of 361 consecutive cases, prospectively collected from January 2012 to June 2016, of women who underwent TLH in St. Chiara Hospital in Trento, Italy. Clinical, demographic, surgical, and intra and perioperative data were recorded. Complications were graded on the Clavien-Dindo morbidity scale. Data were compared with literature. Statistical analysis was performed with SPSS (SPSS Chicago, IL).FindingsMain indication for TLH was uterine fibromatosis (78.6%). Mean uterine size was 327 ± 249 g (range 30–1800 g). Mean operating time was 115 ± 36 min. No laparotomy conversion occurred. Mean length of hospital stay was 2.6 ± 1.1 days (range 1–12 days).Complications requiring surgical intervention in general anesthesia occurred in 3 patients (0.8%): 1 (0.3%) hydroureteronephrosis, 1 (0.3%) bowel adhesions, and 1 (0.3%) port side hernia; complication requiring surgical intervention without general anesthesia occurred in 6 patients (1.6%): 2 (0.6%) hydroureteronephrosis, 1 (0.3%) vaginal cuff dehiscence, and 3 (0.8%) vaginal cuff bleeding.ConclusionsTotal laparoscopic hysterectomy is a procedure with a low incidence of complications. Our data compare favorably with the data of the other listed studies.

Clinical comparison of minimal invasive hysterectomy techniques: laparoscopic hysterectomy vs. vaginal hysterectomy

Purpose: To compare the clinical outcomes of total laparoscopic hysterectomy (TLH) and vaginal hysterectomy (VH). Materials and Methods: A retrospective chart review of 385 women who underwent TLH or VH between November 2012 and October 2013 was accomplished. Clinical outcomes including operation time, hemoglobin change, rate of complications, febrile morbidity, consumption of analgesics, and hospital stay were estimated. Sexual activity and resumption to work of these patients were evaluated according to outpatient medical records and additional questionnaire. Results: There were no differences in outcomes between the two groups other than the mean weight of uterus (VH: 243.93, TLH: 216.94 grams, p = 0.019) and operating time (VH: 97.2, TLH: 142.58 minutes, p p p Conclusions: TLH could be a potent alternative to VH for benign disease, considering its benefits in clinical outcomes and quality of life.

Total Laparoscopic Hysterectomy versus Total Abdominal Hysterectomy in Uterine Tumors

Background: laparoscopic hysterectomy (LH) rates have increased but abdominal hysterectomy (AH) still high and often the first choice for many surgeons even with most of studies reported that the minimal access method offers significant patient benefit over open surgery. Aim of the Work: we aimed to compare the outcome of total laparoscopic hysterectomy as regard the result and safety compared to total open abdominal hysterectomy in cases of uterine tumors. Patients and Methods: this prospective randomized controlled study performed on 25 patients who underwent LH (group 1) compared to 25 patients who underwent AH (group 2). The mean age of the cases, body mass index (BMI), duration of operation, estimated blood loss (EBL), rate of complications, post-operative hospital stay and convalescence time were compared for two groups. Results: LH was associated with a significantly longer operating time (139.96±22.66 minutes vs. 106.54±21.8 minutes P 0.001). As regard intraoperative complications and estimated blood loss there was no difference in both groups. In LH group the pain score and analgesia requirements in post-operative period were significantly less with fewer requiring opioid analgesia. There was a highly significant difference between groups in postoperative wound infection which was higher in AH group. LH was also associated with a significantly shorter inpatient hospital stay (2.22 days vs. 5.52 days P= 0.022) and earlier returned to normal life (7.5 days vs. 20.6 days P<0.001). Conclusion: total laparoscopic hysterectomy is safe and feasible procedure in treatment of uterine tumors with accepted peri-operative morbidity and good improvement of quality of life post-operative.

Outcome of Total Laparoscopic Hysterectomy.

To determine the surgical outcomes of total laparoscopic hysterectomy performed. Case series. Obstetrics and Gynecologic Endoscopic Unit of Patel Hospital, Karachi, from February 2013 till February 2016. The study included all patients on whom total laparoscopic hysterectomy was performed during the study period. Patients with malignancy were excluded from the study, except those with suspected stage 1 and 2 endometrial carcinoma. The procedures were performed by two gynecologists keeping rest of the team constant, with similar technique. The reviewed outcome measures were duration of surgery, and intraoperative and postoperative complications. Out of 209 patients, majority were multiparous with median age and weight of 45 (50-40) years and 69 (80-60) Kgs, respectively. Previous history of abdominopelvic surgery was present in 33%. Heavy menstrual bleeding was the leading indication. Median and interquartile value of operative time was 175 (225-120) minutes. Total rate of intraoperative and postoperative complications was 12.9% and major complications were 3.8%. All postoperative complications were minor. Of all, 3.3% of patients were converted to open surgery; there was no vascular injury or re-operation. Total laparoscopic hysterectomy is safe, acceptable, and doable alternative to conventional standard hysterectomy.

Comparison of cost-effectivenes and clinical outcomes of abdominal, vaginal and total laparoscopic hysterectomy in a selected group

Objective: The aim was to compare the perioperative and postoperative outcomes of total laparoscopic hysterectomy(TLH), total abdominal hysterectomy(TAH), and vaginal hysterectomy(VH) in a selected group of patients.Materials and Methods: Two hundred twenty-three hysterectomies were included in this study. The patients were separated into three groups. Group1 included patients with TLH(n=63); TAH patients were placed in Group 2(n=133), and Group 3 was made up of patients who underwent VH(n=37). All three groups had similar ages, parities, and uterine sizes. The main outcome measures were operation time, fever, need for analgesia, duration of hospital survellience, return to work time, perioperative and postoperative complications, the number of blood transfusions, and costs of the surgery.Results: The total operation time was the shortest in the VH group. There was no significant difference in the hospital survellience duration between the three groups. The VH was found to be the cheapest type of hysterectomy. When the VH group was compared with the TLH group, there was no difference in the use of analgesics for postoperative pain or the time return to work. The VH group patients required more blood transfusions in contrast with the TAH(p=0.001) and TLH groups(p&amp;lt;0.001). Conclusion: VH had similar operative and postoperative outcomes but the shortest duration of operation and the lowest surgical cost compared with the other two techniques.

Total laparoscopic hysterectomyにおける2Dと3D内視鏡システムによる手術成績の比較

Total laparoscopic hysterectomyにおける2Dと3D内視鏡システムによる手術成績の比較

Total Laparoscopic Hysterectomy: A Two-Year Experience in Apollo Hospitals Dhaka

Objective: Aim of our study is to analyze the surgical outcome of total laparoscopic hysterectomy (TLH) in our patient perspective of Apollo Hospitals Dhaka.Methods: This is a retrospective, observational study where we have reviewed demographic data, intraoperative and postoperative outcomes, and morbidity data on 100 women who underwent TLH between January 2011 and December 2012.Results: Total 100 patients were studied. Among them five patient required conversion to laparotomy due to presence of severe adhesion. The major and minor complication rates were 2% (bladder injury-2 cases) and 0% respectively. The average operating time was 148 ± 40 minutes and the mean length of hospital stay was 3±1 day. The average uterine size was 10 ± 4 weeks. In our cases operating time and duration of hospital stay were very similar with lower procedural complications to other published data elsewhere.Conclusion: We have observed that TLH is a safe and acceptable alternative procedure to standard hysterectomy from the patients perspective at Apollo Hospital Dhaka.Pulse Vol.8 January-December 2015 p.21-29

Perioperative Outcomes of Total Laparoscopic Hysterectomy With Uncontained Versus Contained Power Morcellation

Perioperative Outcomes of Total Laparoscopic Hysterectomy With Uncontained Versus Contained Power Morcellation

Comparison of total laparoscopic hysterectomy and abdominal hysterectomy.

Objective:The aim of this prospective study is to evaluate and compare to the outcomes of total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH) who performed in our clinic.Materials and Methods:We performed surgical procedures at Necmettin Erbakan University Faculty of Medicine, Department of Obstetrics and Gynecology between January 2013 and April 2014. Forty patients who underwent TLH (group 1) compared to 40 patients who underwent TAH (group 2). The mean age of the cases, body mass index (BMI), duration of operation, the amount of blood loss, rates of complications and post operative hospital stay were compared for two groups.Results:There were no statistically significant differences between the two groups regarding age, body mass index (BMI), specimen weight, pre-operative hemoglobin (Hb) value and rates of the complications. The mean post-operative Hb value was significantly higher in group 1 than group 2 (11.5±0.8 gr/dl vs. 10.8±1.7, p=0.02). The mean time of operation was significantly longer in group 1 than in group 2 (105.4±22.9 minutes vs. 74±18, p<0.001). The mean duration of hospital stay was statistically shorter in group 1 compared to the group 2 (2.48±0.6 days vs. 4.88±1.2, p<0.001).Conclusion:Total laparoscopic hysterectomy is safe and feasible method for gynecological diseases. TLH may offer specific benefits for properly selected patients. Its advantages are lower peri-operative morbidity, improvement of quality of life, shorter hospital stay and faster return to activity.

Randomized comparison of total laparoscopic, laparoscopically assisted vaginal and vaginal hysterectomies for myomatous uteri

To compare the operative data and early postoperative outcomes of total laparoscopic hysterectomy (TLH), laparoscopically assisted vaginal hysterectomy (LAVH) and vaginal hysterectomy (VH). One hundred and eight women requiring hysterectomy for enlarged myomatous uterus were randomly allocated into three treatment arms: TLH (n=36); LAVH (n=36); VH (n=36). Randomization procedure was based on a computer-generated list. The primary outcome was the discharge time comparison. The secondary outcomes were operating time, blood loss, paralytic ileus time, intraoperative complications, postoperative pain, and early postoperative complications. The mean discharge time was shorter after VH than after LAVH and TLH (P=0.001). Operating time significantly influenced the discharge time, considered as a dependent variable in general linear model analysis (P=0.006). In contrast, blood loss did not influence the discharge time (P=0.55).The mean operating time was significantly shorter in VH than in TLH and LAVH groups (P=0.000).The intraoperative blood loss was greater during LAVH than during TLH and VH (P=0.000).Paralytic ileus time was shorter after VH than after TLH and LAVH (P=0.000). No intraoperative complications or conversion to laparotomy occurred. VH was the faster operative technique with smaller blood loss and shorter discharge time compared with the others two techniques. So, VH should be considered the preferred approach in patients with enlarged myomatous uteri. When VH is not feasible or salpingo-oophorectomy is required, LAVH or TLH should be considered as valid alternatives. It is necessary to continue prospective comparative studies between the various surgical options to identify the best approach for hysterectomy in each single woman.

Feasibility and Outcomes of Total Laparoscopic Hysterectomy in Patients with Obesity versus Morbid Obesity

Feasibility and Outcomes of Total Laparoscopic Hysterectomy in Patients with Obesity versus Morbid Obesity

Evaluation of Total Laparoscopic Hysterectomy With and Without the Use of Barbed Suture

ObjectiveTo evaluate the outcome of total laparoscopic hysterectomy with and without the use of barbed suture. MethodsWe conducted a retrospective study among patients who underwent total laparoscopic hysterectomy between February 2008 and August 2012. The parameters evaluated were age, BMI, operative time, hospital stay, pre- and postoperative hemoglobin levels, uterine weight, intraoperative blood loss, and postoperative complications. ResultsA total of 202 women underwent total laparoscopic hysterectomy; barbed suture (V-Loc) was used in 63 women, and polydioxanone (PDS) in 139. Estimated blood loss, difference in hemoglobin level before and after surgery, operative time, and the duration of hospital stay were comparable between the two groups of patients. The incidence of postoperative fever was higher in the V-Loc group than in the PDS group (P = 0.003). Multiple linear regression analysis showed that the incidence of postoperative fever was related to BMI (P = 0.02, r = 0.22) and estimated blood loss (P = 0.004, r = 0.28) and not to age, operative time, or uterine weight. ConclusionThe use of barbed suture to close the vaginal vault after laparoscopic hysterectomy, compared with standard suture, results in similar operative time, blood loss, and duration of hospital stay. The use of barbed suture is technically less demanding than the use of regular sutures.

Risk Profiles and Outcomes of Total Laparoscopic Hysterectomy Compared With Laparoscopically Assisted Vaginal Hysterectomy

With the increasing rates of minimally invasive hysterectomy procedures serving as impetus, the aim of this study was to analyze the 30-day risk profiles associated with total laparoscopic hysterectomy and laparoscopically assisted vaginal hysterectomy (LAVH). The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent a total laparoscopic hysterectomy or LAVH operation between 2006 and 2010. Patient demographics and 30-day complication rates were calculated. Multivariable regression analyses were used to study the effect of hysterectomy approach on outcomes. A total of 6,190 patients underwent laparoscopic hysterectomy, with 66.3% receiving LAVH and 33.7% receiving a total laparoscopic hysterectomy. The patient cohorts were well-matched. Although total laparoscopic hysterectomy procedures were significantly longer than LAVH operations (2.66 hours compared with 2.20 hours; P<.001), there was no difference in overall morbidity or reoperation rates between the LAVH and total laparoscopic hysterectomy populations (7.05% compared with 6.3% for overall morbidity; 1.3% compared with 1.7% for reoperation). Regression analyses revealed that surgical approach was not a significant predictor of overall postoperative morbidity or reoperation in minimally invasive hysterectomy patients. Additionally, obesity did not demonstrate a significant association with morbidity or reoperation rates; however, operative time was found to be a significant predictor of reoperation (odds ratio 1.23, 95% confidence interval 1.07-1.42). Laparoscopic hysterectomy is well-tolerated with total laparoscopic hysterectomy and LAVH, yielding comparable rates of postoperative morbidity and reoperation. On average, LAVH procedures were 28 minutes faster than total laparoscopic hysterectomy. Additionally, increasing body mass index was not associated with higher rates of morbidity. II.

Total Laparoscopic Hysterectomy versus Vaginal Hysterectomy at the University Hospital of the West Indies: A 5-year Retrospective Study

To compare the outcomes of total laparoscopic hysterectomy (TLH), a relatively new procedure, with vaginal hysterectomy (VH), a well-established procedure, in a university teaching hospital. A retrospective chart review of all patients who underwent TLH at the University Hospital of the West Indies between January 2007 and December 2011 was conducted. Chart review was also conducted of a group of patients who underwent VH during this time period. The groups were compared with respect to demographic data and intraoperative and postoperative outcomes. Statistical analysis was undertaken using the SPSS software, version 12.0 (SPSS, Chicago, IL). The Student unpaired t-test was used to analyse continuous variables, and the Chi-square test and Fisher exact test for categorical variables, when appropriate. A p-value of < 0.05 was considered statistically significant. Ten patients underwent TLH, and were compared with 22 women who underwent VH. There was no statistically significant difference between groups in uterine weight, estimated blood loss, postoperative analgesic requirement, or length of hospitalization. Total laparoscopic hysterectomy took significantly longer to perform (209.9 vs 145.6 minutes, p = 0.004). One patient in the TLH group had to be brought back to the operating theatre after three months because of bowel prolapse secondary to vault dehiscence. With the exception of one case of bladder injury in the VH group, there were no significant differences between the groups in terms of intraoperative and postoperative complications. Total laparoscopic hysterectomy, notwithstanding its learning curve, is as safe as VH However, TLH was associated with a significantly longer operative time.

Comparison of morbidity by uterine weight in total laparoscopic hysterectomy

Objective: To evaluate the effect of uterine weight on short-term outcome of total laparoscopic hysterectomy (TLH) for benign gynecological conditions. Methods: A retrospective medical records review of 265 cases of patients with TLH was performed. Patients included in this study underwent TLH as benign uterine disorders at Kangnam Sacred Heart Hostpital, Hallym University from January 2008 through June 2009. These patients were stratified into three groups; Group 1 patients with uterus weighing less than 180 g (n=60), Group2 patients with uterus weighing 180 g to 350 g (n=141), Group 3 patients with uterus weighing more than 350 g (n=64). The groups were compared as regard postoperative stay, operative time, estimated blood loss, hemoglobin change, conversion to open surgery, and postoperative complications. Results: There was no significant difference in age, gravidity, body mass index, previous pelvic surgery and past medical history. The overall complication rates were not significantly different. But operative time prolonged as uterine weight increased. Conclusion: The TLH can be performed successfully in case of enlarged uterus. Therefore the enlarged uterus is not an absolute contraindication for TLH.

Total Laparoscopic Versus Vaginal Hysterectomy: A Retrospective Comparison

ObjectivesTo compare the outcomes of total laparoscopic hysterectomy (TLH) and vaginal hysterectomy (VH) in a community teaching hospital. MethodsA retrospective chart review of all women who underwent TLH and VH at North York General Hospital between January 2002 and December 2004 was conducted. Groups were compared with respect to demographic data, and intraoperative and postoperative outcomes. ResultsOne hundred nine women underwent TLH, and 43 women underwent VH. There was no statistically significant difference between groups in the mean age of patients, estimated blood loss, or mean postoperative hemoglobin change. TLH took significantly longer to perform (104.4 vs. 54.4 minutes, P < 0.001); however, the mean postoperative duration of hospital stay was greater in the VH group (2.2 vs. 1.2 days, P < 0.001). Mean uterine mass was significantly greater in the TLH group (290.9 vs. 151.6 g, P < 0. 001). The incidence of intraoperative and postoperative complications was slightly higher in the TLH group than in the VH group, but the difference did not reach statistical significance. ConclusionsTLH was associated with significantly longer operative time and shorter hospital stay than VH. There was a trend towards more intraoperative and postoperative complications in the TLH group than in the VH group.

Total laparascopic hysterectomy at The Aga Khan University Hospital, Nairobi

To determine the outcomes of total laparoscopic hysterectomy at the Aga Khan University Hospital, Nairobi. To create awareness on the availability of the procedure and to recommend the procedure as a suitable option to total abdominal hysterectomy. A retrospective case analysis. Private practice in a private hospital set up. One hundred and twelve laparoscopic hysterectomies were performed at the Aga Khan University Hospital, Nairobi. These cases have been reviewed, analysed and presented between May, 2000 and May, 2007. Total laparoscopic hysterectomies done. All cases performed at other hospitals in Nairobi and Mombasa, and all cases where the author was not the principal surgeon. The ages ranged from 36 to 74 years, the mean age being 48 years. The patients parity ranged from 0 to 9. Fifty seven point one percent of the patients presented with heavy prolonged periods with clots. Of all the cases performed 54.4% gave a history of a previous laparotomy or Caesarian section. The uterine size by clinical assessment ranged from bulky to 28 weeks. The operating times ranged from 25 to 240 minutes, scope in to scope out. The average hospital stay for patients undergoing total laparoscopic hysterectomies was 2.1 days. There were no intraoperative complications encountered. The majority of the uteri weighed between 101-300 g (50.8%). Laparoscopic surgery is now well accepted by specialists and patients. Where facilities allow advocating total laparoscopic hysterectomy for benign uterine pathology can be considered as a suitable option to abdominal hysterectomy.

Total Laparoscopic Hysterectomy: A Five-Year Experience

ObjectiveTo review the surgical outcomes of total laparoscopic hysterectomy (TLH) over a five-year period in a teaching community hospital. MethodsWe reviewed demographic data, intraoperative and postoperative outcomes, and morbidity data on 175 women whounderwent TLH between January 2001 and December 2005. ResultsNo bowel or urinary tract injury occurred in any of the patients. The major and minor complication rates were 4.0% and 2.9% respectively. The mean operating time was 108.2 minutes, standard deviation (SD) 29.6 minutes, range 60–199 minutes, and the mean length of hospital stay was 1.2 days, SD 0.4 days. The mean uterine weight was 292.9g, SD 206.3g, with the largest specimen weighing 1126g. ConclusionThe cases reported here had operating times and lengths of hospital stay that were similar to those in previously published reports, and the complication rate was lower than in previous reports. TLH is a safe and acceptable alternative to standard hysterectomy.

Total Laparoscopic Hysterectomy for Very Enlarged Uteri

Study ObjectiveTo evaluate short-term outcome of total laparoscopic hysterectomy (TLH) performed in women with very enlarged uteri. DesignCase control study (Canadian Task Force classification II-2). SettingHospital gynecologic service. PatientsThirty-four consecutive women with very enlarged uteri. InterventionTotal laparoscopic hysterectomy for benign pathology. Measurements and Main ResultsWomen with uterine enlargement (group 1) were compared with 68 women with uteri weighing 300 g or less (group 2) who underwent TLH during the same period. Matching was based on patient age ± 2 years, surgeon (experienced senior, fellow), whether or not Burch operation was performed, and whether or not adnexectomy was performed. The groups were compared for complication rates, operating time, hospital stay, change in perioperative hemoglobin concentration, and vaginal and laparoscopic uterine morcellation. They did not differ statistically significantly in terms of indications for surgery, parity, postmenopausal status, and preoperative hemoglobin levels. No difference was seen in complication rates between groups. Operating time was significantly shorter (p <0.001) in women with smaller uteri than in those with very enlarged uteri, 108 ± 35 and 156 ± 50 minutes, respectively. The groups did not differ significantly in day 1 hemoglobin level drop, analgesia requirement (oral, intravenous opioid), time to passing gas and stool, or hospital stay. No conversion to laparotomy was required in either group. ConclusionA very enlarged uterus should not be considered a contraindication for TLH. However, it may be necessary to undertake certain surgical steps to ensure optimal exposure of the operative field and more effective and safer excision of the uterine vascular pedicle.