Total Abdominal Hysterectomy Group Research Articles

Surgical Site Infection in Laparoscopic Hysterectomy versus Abdominal Hysterectomy in Gynecological Disease(s): An Overview.

Surgical site infection (SSI) is an unsettled complication seen in any surgery. The aim of this study is to assess the rate of postoperative SSIs between total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH). Can the rate of SSI be reduced with the use of a laparoscopic mode of hysterectomy over abdominal? It was a retrospective comparative study. The study was conducted in the obstetrics and gynecology department at a tertiary care center from June 2016 to March 2020. A total of 300 patients who underwent hysterectomy either via laparoscopic or abdominal route were included in the study. They were subdivided into two groups: a total of 167 underwent TLH (Group 1) and 133 had TAH (Group 2). The results were compared. It included the age and body mass index of the patient, indication of surgery, size of the uterus, intraoperative blood loss, postoperative SSIs, duration of hospital stay, and readmission rates. It was found a high rate of SSI in TAH (82.4% vs. 17.6%, P < 0.001, Cramer's V-0.18), the operative time taken (75 ± 25 min vs. 128 ± 52 min, P < 0.001), and the mean blood loss during TLH (110 ± 30 ml vs. 160 ± 116 ml, P < 0.001) was found significant for patients. The hospital stay after TLH was found to be significantly shorter (4 ± 2.47 days vs. 7 ± 2.43, P < 0.001). TLH has improved the psychological, physical, and financial burden on the health care department. Thus, it has proved a preferred route over TAH.

A Comparison between Total Abdominal Hysterectomy versus Total Laparoscopic Hysterectomy.

To compare the operative and postoperative outcomes of total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH). In this retrospective comparative study, we reviewed all hysterectomies performed in the Al-Karak Governmental Hospital in Al-Karak, Jordan, from September 2018 to July 2022. We enrolled 129 patients who underwent hysterectomy. The patients were divided into the TLH (n = 39) and TAH (n = 90) groups. Patient data were accessed through hospital records and analyzed using SPSS 25.0. The most common indication for TLH was uterine fibroid, and that for TAH was abnormal uterine bleeding, although the specimen weights were comparable. There was no significant between-group difference in the patient's demographics. Although the TLH group had longer operative time, the hospital stay was shorter and there were no reported cases of wound infection. The estimated blood loss was significantly lower in the TLH group than in the TAH group, but there was no difference between the two groups in terms of blood transfusion requirement and postoperative hemoglobin level. TLH and TAH had comparable overall outcomes in the Al-Karak Governmental Hospital. However, TLH was superior to TAH in terms of blood loss, and patients with TLH recovered faster without postoperative wound infection.

Application of Uterus Manipulator in Total Abdominal Hysterectomy for Benign Diseases.

Pelvic access is a challenging matter in abdominal hysterectomy especially in obese patients and presence of pelvic adhesions. Uterus manipulators (UM) have been used in a number of studies on laparoscopic approach to improve surgical performance. This study aimed to assess the impact of UM application on the operation time and blood loss in total abdominal hysterectomy (TAH) for benign diseases. Forty-one patients aged 34 to 56 years were enrolled for abdominal hysterectomy - 20 as the case group (hysterectomy with UM application) and 21 as the control group (conventional hysterectomy). In the case group, UM was used after uterus artery ligation during TAH. The control group underwent traditional TAH. The mean operation time was significantly less in TAH with UM compared to traditional TAH (90.23 ± 10.54 minutes vs. 140.5 ± 16.61 minutes; p-value<0.001). The mean decline between preoperative and 12-hour postoperative hemoglobin was 0.74 ± 0.23 mg/dL in the TAH with UM group and 1.65± 1.02 mg/dL in the traditional TAH group (p-value<0.001). Also, no difference was detected in intra- and post-operative complications. The current study showed that, using UM is beneficial in total abdominal hysterectomy by decreasing the operative time and blood loss.

Comparison of Outcomes of Total Laparoscopic Hysterectomy versus Total Abdominal Hysterectomy

Background: Hysterectomy is the most common gynecological procedure performed worldwide. Recently, total laparoscopic hysterectomy (TLH) has been presented as an effective substitute for total abdominal hysterectomy (TAH). Objective: To compare operative and postoperative outcomes of TLH with TAH. Methods: This Quasi-experimental study was conducted at the department of Obstetrics and Gynecology of Hameed Latif hospital, Pakistan from December 2018 to June 2019. A total of 116 patients (58 in each group) undergoing hysterectomy, meeting the selection criteria were included in the study. Intraoperative and postoperative evaluations included intraoperative blood loss estimation and post-operative hospital stay. All data were recorded in a predesigned study proforma. Data were analyzed through SPSS version 23. Results: The mean age of patients in TLH and TAH was 47.28±4.62 years and 47.22±4.72 years respectively. The mean blood loss in the TLH group was 216.28±149.85 ml and in TAH group was 371.38±147.16 ml with statistically significant lower mean blood loss in TLH group (p-value &lt; 0.001). Mean duration of hospital stay in the TLH group was 2.28±1.23 days and in the TAH group versus 3.86±1.30 days in TAH group (p-value &lt; 0.001). Conclusion: Mean blood loss and hospital stay were statistically lower in TLH when compared with TAH. Adequate training of the staff can ensure adoption of laparoscopic procedure due to improved intraoperative and postoperative outcomes.

A Comparative Study of Nondescent Vaginal Hysterectomy versus Total Abdominal Hysterectomy

Background: Hysterectomy is the most common operation performed for benign uterine conditions. It can be done through abdominal, vaginal and laparoscopic routes 1,2.The American college of Obstetricians and Gynaecologists recommends the vaginal approach as the route of choice of hysterectomy for benign disease whenever feasible 9 .Laparoscopic hysterectomy is a preferable alternative to open abdominal hysterectomy for those patients in whom vaginal hysterectomy is not indicated or feasible. Objective(S): To compare the surgical outcome of total abdominal hysterectomy (TAH) and non-descend vaginal hysterectomy (NDVH). Methods: This is a cross sectional and comparative study that was conducted from January 2014 to December 2015 in Obstetrics and Gynaecology Department of Sylhet Shaheed Shamsuddin Ahmed Hospital, Sylhet. A Total of 120 patients with benign gynaecological disorder who underwent hysterectomy were included. Among them 60 cases underwent NDVH and 60 cases underwent TAH for similar indication. Main Outcome measures are: i) Duration of operation (min) ii) intra and post-operative complications iii) blood loss (ml) during operation iv) Analgesic requirements v) post-operative hospital stay. Results: Most of the patients in both NDVH and TAH belonged to age group of 41-50 years. Majority of them were multiparousin both the groups. Medical co morbidities were Diabetes mellitus, Hypertension, Hypothyroidism and most common surgical co morbidities were history of lower segment cesarean section (LSCS), bilateral tubal ligation, laparotomy for benign ovarian pathology. Common indication for hysterectomy in NDVH was abnormal uterine bleeding (AUB) (37%) and in TAH was (18%), fibroid uterus 35% cases in NDVH and 37% in TAH. Mean operative time of NDVH group was 51.08±12.59 minutes while that of women in TAH group was 69.25±11.12 minutes. This difference was found to be statistically significant (p&lt;0.05 when df 118). The mean blood loss in NDVH group was 61.08±18.82 ml while in TAH group was 105.50±38.42 ml, this is also statistically significant (p&lt;0.05). Analgesic required in NDVH group 5.91±0.97 doses and in TAH was11.58±2.67 doses which is statistically significant(p&lt;0.05).11(18%) patients developed wound infection in TAH group, but none of the patients of NDVH group developed wound infection which is significant. Post-operative hospital stay in NDVH group was 3.02±1.43 days and those in TAH group was 7.7±3.40 days this is also statistically significant. Conclusions: NDVH is safe, feasible and effective procedure and associated with less blood loss during surgery, decrease operative time, less intra-operative and post-operative complications with shorter hospital stay as compared total abdominal hysterectomy. Hence NDVH is a better option for females requiring hysterectomy for benign conditions.

Comparison of vaginal, abdominal and laparoscopic hysterectomy performed in our hospital

Hysterectomy is the most common pelvic surgical operation and is often performed for benign reasons. We aimed to compare clinical total abdominal hysterectomy (TAH), total laparoscopic hysterectomy (TLH), and vaginal hysterectomy (VH) in benign gynecological conditions. Patients' age, operation duration (min), length of stay in the hospital (days), Preop Hb (g/dL), Postop Hb (g/dL) values, complications according to the performed surgical procedures were analyzed. Determining which procedure will be the most appropriate option for which patient is the most important factor in preventing complications. it was observed that the patients' ages were significantly higher in the VH group (H=71.721; p=0.000), the operation duration was significantly shorter in the TAH group (H=125.689; p=0.000), and the length of hospital stay was significantly shorter in the TLH group (H=71.492; p=0.000). Preoperative and postoperative hemoglobin values were significantly higher in the VH group (H=57.222; p=0.000, H=52.824; p=0.000). It was determined that the complication rate was lower in the TAH group. The type of surgical procedure was found to not have a statistically significant effect on transfusion requirement (χ2=4.852; p&gt;0.05) and history of previous surgery (χ2=0.115; p&gt;0.05). The surgical approach of hysterectomy plays a significant role in postoperative morbidity. Determining which procedure will be the most appropriate option for which patient is the most important factor in preventing complications.

The effect of hysterectomy types on vaginal length, vaginal shortening rate and FSFI scores

ObjectiveVaginal length (VL), size and width may show individual differences among women. Hysterectomy causes VL shortening in patients, and this shortening varies according to the type of hysterectomy performed. Some studies in literature have shown that the shortened VL after hysterectomy may cause dyspareunia and have a negative effect on female sexuality. The aim of this study is to compare preoperative and postoperative vaginal lengths, vaginal shortening rate (VSR) not used before in the literature, and postoperative sexual functions according to hysterectomy types. Materials and methodsIn the study, which included 136 [55 Total Abdominal Hysterectomy (TAH), 33 Vaginal Hysterectomy (VH), 48 Total Laparoscopic Hysterectomy (TLH)] sexually active patients under the age of 60 who underwent hysterectomy, the patients were divided into three groups according to the type of hysterectomy performed. Groups were compared in terms of demographic variables, preoperative/postop and control VL, vaginal shortening rate and The Female Sexual Function Index (FSFI) scores. ResultsVaginal lengths measured after TLH was longer and vaginal lengths measured after VAH was shorter, the difference was significant (p < 0.01). VSRs were 15.9% in TAH group, 10.9% in VH group and 8.3% in TLH group (p < 0.05). Total FSFI score was higher in TLH group than TAH and VH group (p < 0.01). Group of VSR>15% had statistically significantly lower FSFI scores in lubrication, orgasm, pain and total score than both the VSR<10% group and the VSR 10–15% group (p < 0.05). ConclusionCalculating the VSR after hysterectomy instead of postoperative VL measurement will allow us to obtain more individual and accurate results in predicting postoperative sexual functions. We found that TLH is the best hysterectomy method in terms of preserving sexual functions due to less loss of vaginal tissue in the postoperative period from these three techniques that are frequently.

Quality of life and sexual function after abdominal versus laparoscopic hysterectomy: a prospective study.

This study aimed to evaluate the quality of life (QoL) and sexual function of women who underwent total abdominal hysterectomy and total laparoscopic hysterectomy. In this prospective cohort study, a total of 121 patients who underwent total abdominal hysterectomy (N.=65) and total laparoscopic hysterectomy (N.=56) operations for benign indications were included. Sociodemographic features, obstetric histories, and clinical characteristics of the patients were noted. Quality of life assessment was conducted with the World Health Organization Quality of Life-BREF questionnaire, which has five domains: overall quality of life + health, physical health, psychological health, social relationships, and environment. Sexual function was assessed by the Golombok-Rust Inventory of Sexual Satisfaction Scale with subscales of infrequency, non-communication, avoidance, non-sensuality, dissatisfaction, vaginismus, and anorgasmia. The patients were asked to fill in both questionnaires before the operation and six months after the operation. Of the 121 patients, 104 of them completed the postoperative surveys. In the total laparoscopic hysterectomy group, the individual improvements of the overall quality of life + health physical, and psychological health domains were statistically higher than the total abdominal hysterectomy group. In terms of sexual function, the total abdominal hysterectomy group had worse avoidance, non-sensuality, dissatisfaction, and vaginismus subscale scores and total score both in the preoperative and postoperative period compared to the total laparoscopic hysterectomy group. However, the individual differences and the number of patients exhibiting sexual dysfunction before and after surgery were not statistically significant in both groups. Laparoscopic hysterectomy was superior to abdominal hysterectomy in improving the quality of life of the patients. Both abdominal and laparoscopic hysterectomies were not found to affect female sexuality.

A retrospective comparative analysis of systemic inflammatory response after laparoscopic, vaginal, and abdominal hysterectomy

Background: Lymphocyte to neutrophil ratio (NLR) is a rapid and simple marker for systemic inflammation and stress after major surgery. In this study, we aimed to compare NLR changes according to surgical methods of hysterectomy. Methods: A retrospective chart review for all patients who underwent hysterectomy for benign uterine disease from 2016 to 2020 was performed. A total of 1549 women were assigned to total laparoscopic hysterectomy (TLH) (n = 419), vaginal hysterectomy (VH) (n = 608), and total abdominal hysterectomy (TAH) (n = 522) groups. Patient characteristics, surgical outcomes, and NLR changes were compared among women who underwent TLH, VH, and TAH. Results: Preoperative mean NLR was similar among three groups (p = 0.056). However, mean NLR on postoperative day 1 (p&lt; 0.0001) and day 3 (p = 0.011) was significantly lower in TLH group than others. Also, mean NLR change on postoperative day 1 was significantly lesser in TLH group than others (1.9 in TLH vs. 5.4 in VH vs. 4.7 in TAH; p &lt; 0.0001). Mean NLR change on postoperative day 3 was greater in TAH group than others, although there were no statistically significant differences (0.2 in TLH vs. 0.3 in VH vs. 0.7 in TAH; p = 0.354). Multivariate analysis revealed that massive NLR change (&gt;5.0) on postoperative day 1 was significantly associated with types of hysterectomy (p &lt; 0.0001). Conclusion: Our data showed that acute NLR change was lesser in TLH group comparing to VH and TAH group, which suggests that TLH might be associated with less systemic inflammation and tissue trauma after surgery.

Recurrence and survival after laparoscopy versus laparotomy without lymphadenectomy in early-stage endometrial cancer: Long-term outcomes of a randomised trial

BackgroundLaparoscopic hysterectomy is accepted worldwide as the standard treatment option for early-stage endometrial cancer. However, there are limited data on long-term survival, particularly when no lymphadenectomy is performed. We compared the survival outcomes of total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH), both without lymphadenectomy, for early-stage endometrial cancer up to 5 years postoperatively. MethodsFollow-up of a multi-centre, randomised controlled trial comparing TLH and TAH, without routine lymphadenectomy, for women with stage I endometrial cancer. Enrolment was between 2007 and 2009 by 2:1 randomisation to TLH or TAH. Outcomes were disease-free survival (DFS), overall survival (OS), disease-specific survival (DSS), and primary site of recurrence. Multivariable Cox regression analyses were adjusted for age, stage, grade, and radiotherapy with adjusted hazard ratios (aHR) and 95% confidence intervals (95%CI) reported. To test for significance, non-inferiority margins were defined. ResultsIn total, 279 women underwent a surgical procedure, of whom 263 (94%) had follow-up data. For the TLH (n = 175) and TAH (n = 88) groups, DFS (90.3% vs 84.1%; aHR[recurrence], 0.69; 95%CI, 0.31–1.52), OS (89.2% vs 82.8%; aHR[death], 0.60; 95%CI, 0.30–1.19), and DSS (95.0% vs 89.8%; aHR[death], 0.62; 95%CI, 0.23–1.70) were reported at 5 years. At a 10% significance level, and with a non-inferiority margin of 0.20, the null hypothesis of inferiority was rejected for all three outcomes. There were no port-site or wound metastases, and local recurrence rates were comparable. ConclusionDisease recurrence and 5-year survival rates were comparable between the TLH and TAH groups and comparable to studies with lymphadenectomy, supporting the widespread use of TLH without lymphadenectomy as the primary treatment for early-stage, low-grade endometrial cancer.

Comparative Study of Non-descent Vaginal Hysterectomy with Total Abdominal Hysterectomy

IntroductionHysterectomy is the most common operation performed by gynecologist worldwide. In the present era emphasis is given on minimal invasive surgery so Non-Descent Vaginal Hysterectomy (NDVH) has gained more interest over Total abdominal Hysterectomy (TAH). NDVH has several benefits over TAH in terms of blood loss, operating time, post-operative complications, recovery and hospital stays. The objective of the study was to compare the clinical outcome of NDVH over TAH with respect to operating time, blood loss, hospital stays, intraoperative and early postoperative complication and to find out the most efficient route for hysterectomy. MethodsThe study was conducted at College of Medical Science-Teaching Hospital, Bharatpur, Chitwan, Nepal between May 2017- May 2020. Fifty cases each of NDVH and TAH group fulfilling the selection criteria were included in the study. Outcome was measured on the basis of operating time, blood loss, hospital stay and intra an d post-operative complications. ResultsBaseline characteristics were similar between both the groups. The most common indicationfor hysterectomy in both the group was fibroid uterus. There was no intra-operativecomplication in NDVH group but in TAH group bowel injury was encountered in 3 cases.The operating time, blood loss, hospital stay and post-operative complications were less inNDVH as compare to TAH ConclusionsNDVH is the better choice of surgery than TAH for the non-prolapsed uterus, size less than12 weeks with benign pathology.

Does laparoscopic hysterectomy\u2009+\u2009bilateral salpingectomy decrease the ovarian reserve more than total abdominal hysterectomy? A cohort study, measuring anti-M\xfcllerian hormone before and after surgery

BackgroundDecreased ovarian function and reserve is one of the complications of hysterectomy. In this study, we aimed to compare anti-müllerian hormone (AMH) levels between total abdominal hysterectomy (TAH), and total laparoscopic hysterectomy (TLH).MethodsIn this prospective cohort study, serum levels of AMH were compared between the groups undergoing TAH + bilateral salpingectiomy and TLH, in 66 patients (33 in each group) who referred to the hospitals of Shiraz University of Medical Sciences for hysterectomy during one years of work. The collected information included age, weight, gravidity, parity, regularity of menstrual cycle, uterine weight, blood loss during surgery, and serum levels of AMH before and 6 months after surgery, compared between groups.ResultsMost patients (88% in TAH and 73% in TLH group) aged 40–50 years. Mean age, weight, parity of patients was similar in both groups, while blood loss was significantly less in TLH group (P < 0.01). Median (IQR) of pre-surgical AMH values were 0.40 (0.55) ng/ml in the TLH group and 0.92 (1.23) ng/ml in the TAH group (P = 0.12) that decreased to 0.29 (0.44) ng/ml in the TLH group and 0.15 (0.31) ng/ml in the TAH group (P = 0.02). Also Median (IQR) of the difference between pre and post-surgical AMH values were 0.12 (0.31) and 0.58 (1.17) in TLH and TAH group, respectively (P = 0.003).ConclusionThe serum levels of AMH decreased significantly after both methods of hysterectomy (laparoscopy and laparotomy), while this decrease was greater in TAH group that shows.

22 Randomized trial of laparoscopic versus abdominal hysterectomy for benign indications and impact on surgical success

To examine the differences in patient-centered goals in individuals undergoing laparoscopic versus abdominal hysterectomy for benign indications. This abstract is a sub-analysis of a prospective, randomized controlled trial examining the impact of laparoscopic versus abdominal hysterectomy on patient-centered outcomes including quality of life, pain, and productivity. At each pre-operative visit, each participant reported top three patient-centered goals they hoped to achieve prior to undergoing a hysterectomy. In addition, participants rated their subjective achievement of goals from 1 to 10, with 1 (goal not achieved) and 8 to 10 (goal achieved). The subjects were then randomized to total laparoscopic (TLH) or total abdominal hysterectomy (TAH). Following surgery, repeat assessment of goal achievement was obtained within each group on post-operative day 1, at 6 weeks, 6 months than 12 months post-operatively. In addition, the length of time to successful goal achievement (scores of 8 or higher during any post-operative period) was recorded in all participants. Power analysis was based on differences in the primary outcome of the initial study: Quality of Life as scored by the SF-36 form. With a clinically significant differences of 15 points in the SF-36 required a sample size of 29 patients in each group for a power of 80% with a two-sided significance level of 0.05. With that, differences in goal achievement rates and the length of time to goal achievement were examined between TLH and TAH groups using the calculated sample size of the initial study. A total of 91 participants undergoing benign hysterectomy were enrolled and randomized. Three patients were lost to follow-up, with 88 subjects available for final analysis. The top three goals listed respectively were: “Abnormal Uterine Bleeding,” (AUB) “Pelvic Pain,” (PP) and “Quality of Life.” (QOL). Overall, there were no significant differences in the percentage of goal achievement between TLH and TAH groups for QOL (69% vs 67%, P = 0.88), for AUB (67% vs 51%, P = 0.14), and PP (53% vs 49%, P = 0.67), though it appears that participants who listed QOL as their top goal were more likely to achieve the goal. The mode of hysterectomy did not appear to alter differences in goal achievement. In addition, there were no significant differences in the length of time to goal achievement between TLH and TAH groups for QOL (156 days vs 159 days, P = 0.99), for AUB (96 vs 116, P = 0.25), and PP (146 vs 143, P = 0.80). In conclusion, there were no significant differences in goal achievement rates between TLH versus TAH groups regardless of the desired patient-centered goals, though the majority of participants achieved their respective goals in both groups. In addition, there were no differences in length of time to goal achievement between the two groups. This study suggests that a hysterectomy itself may have a therapeutic effect on patient-centered outcomes irrespective of the route of surgery.

Deciding the Appropriate Route and Method of Hysterectomy for Women with Benign Diseases: A Cross-sectional Study at a Tertiary Care Hospital, India

Introduction: Different factors may influence the route of hysterectomy for benign indications. Each of the three main approaches of hysterectomy has its own set of risks and benefits. A rational and evidence-based decision to select a right method for a particular patient is necessary to bring about the best possible outcome with least complications. Aim: To compare three groups of hysterectomy, i.e., laparotomy for Total Abdominal Hysterectomy (TAH), Non-descent Vaginal Hysterectomy (NDVH) and Total Laparoscopic Hysterectomy (TLH), with regard to the patient and clinical factors, surgical outcomes and complications, in order to decide the optimum route and method of hysterectomy in a patient with benign disease. Materials and Methods: In this hospital-based cross-sectional study, 120 women, with 40 patients each in the TAH, NDVH and TLH groups, were admitted due to benign gynaecological conditions in a tertiary care hospital in Kolkata, India from May 2013 to April 2014. They were operated, and then followed-up at 6-12 weeks after surgery. All the relevant information, e.g., clinical diagnosis, operating time, intraoperative blood loss, length of stay in hospital, postoperative pain score, intraoperative and postoperative complications, etc., were recorded. Data were analysed statistically by simple proportions and statistical tests, i.e., Chi-square test and F-test. Results: The most common indication for hysterectomy was benign diseases in all the groups, 47.5%, 40% and 37.5%, respectively in the TAH, NDVH and TLH groups. The mean operating time (minutes) was significantly higher in the TLH group (163.5) as compared to the TAH (75.03) and NDVH groups (84.88) (p=0.039). A significantly lesser mean intraoperative blood loss (mL) was observed in the NDVH (85.67) and TLH groups (98.63) as compared to the TAH group (168.47) (p=0.021). The observations in regard to other surgical outcome parameters, i.e., postoperative pain score, hospital stay, were also favourable in the NDVH or TLH group. The complication rate was higher in the TAH group (22/40 or 55%) as compared to the NDVH (14/40 or 35%) and TLH (17/40 or 42.5%) groups. Conclusion: NDVH or TLH is the preferred method over TAH in case of benign uterine disease due to lesser operative morbidity and faster recovery.

Do hysterectomy techniques affect sexual functions and lower urinary system complaints?

Aim: Hysterectomy is the most common gynecological surgical procedure. Therefore, detailed consultation about the postoperative effects of hysterectomy is an integral part of the operation. However, available data on these issues are limited and conflicting. The aim of this study is to evaluate the effects of hysterectomy types on lower urinary tract symptoms (LUTS), sexual function and quality of life. Methods: Patients between 38-60 years of age who underwent total laparoscopic hysterectomy (TLH), vaginal hysterectomy (VH), and, in addition to standard total abdominal hysterectomy (TAH), uterosacral ligament-cuff suturing operation between June 2017 and 2019 were included in this cross-sectional study. Urgency, urge incontinence, frequency, abnormal emptying, hesitancy, nocturia, overflow, and interrupted stream are considered LUTS symptoms. Sexual functions were evaluated by Index of Female Sexual Function Index (FSFI) and the quality of life was evaluated by the EQ-5D (European Quality of Life Five- Dimension Scale) during the post-operative period. Results: There was a significant decrease in urgency, urge incontinence, frequency, abnormal emptying, nocturia and interrupted stream symptoms (P<0.05) in the VH group (n=30), and urge and urge incontinence symptoms in TAH group (n=213) (P<0.05) postoperatively. In terms of the FSFI total score, the highest sexual dysfunction was in the TAH group whereas the lowest was in the TLH (n=60) group. Conclusions: Hysterectomy does not worsen LUTS. The best post-operative sexual functions were found in the TLH group. The post-operative quality of life was better in patients operated vaginally and laparoscopically.

A comparative study between Total Laparoscopic Hysterectomy (TLH) and conventional Total Abdominal Hysterectomy (TAH) in non-neoplastic uterine diseases

Introduction:In the past decade, laparoscopic route of surgery has been on an increase especially for non-neoplastic uterine diseases. The present study aims to study and compare between Total Laparoscopic Hysterectomy (TLH) and conventional TAH (Total Abdominal Hysterectomy) in terms of characteristics like blood loss, operative time, intraoperative complications, postoperative pain & mobilisation, analgesic requirements, duration of hospital stay and finally patient satisfaction. Materials and methods: In this randomized prospective comparative study, 100 consecutive patients of hysterectomy (50 each of total TAH and TLH) at a tertiary care center in western India, were recruited. The present study aims to study and compare between TLH and conventional TAH (Total Abdominal Hysterectomy), in non-neoplastic uterine diseases, in terms of characteristics like blood loss, operative time, intraoperative complications, postoperative pain & mobilisation, analgesic requirements, duration of hospital stay and finally patient satisfaction. Results: We observed that average blood loss, postoperative pain and analgesic requirement and mean length of hospital stay in TLH was lesser than TAH group (p< 0.001). An average time taken for TLH as well as patient satisfaction level was more (p< 0.001) than that in TAH group. Intraoperative complications were comparable and not significantly different among the two procedures. Mobilization after the procedure was quicker in laparoscopic hysterectomy. Mobilization of patients during postoperative period was significantly earlier (p< 0.0001) in TLH group (12.2 hours) while in TAH (22.3 hours. Patient satisfaction level was 90% in patients in TLH group while only 60% for patients in TAH group. Conclusion: TLH is a safe and effective method of doing hysterectomy and it is a good alternative of conventional abdominal hysterectomy, especially after good training to standardized the procedure, proper case selection, day to day practice of the technique and application of sound surgical principles.

Laparoscopic hysterectomy versus total abdominal hysterectomy: a retrospective study at a tertiary hospital

ObjectiveTo compare laparoscopic hysterectomy (LH) with total abdominal hysterectomy (TAH) regarding different outcome measures at our tertiary hospital.Study designThis retrospective comparative cross-sectional study was conducted at the Department of Obstetrics and Gynecology Department, Women’s Hospital, Hamad Medical Corporation, Doha, Qatar. It included 44 patients who had LH (group 1) and 95 patients who had TAH (group 2) during the period from January 2009 through June 2014.ResultsThree patients were converted from LH to TAH and were excluded from the final analysis. The size of the uterus was smaller in the LH group than the TAH group (7.38 ± 1.92 vs 10.25 ± 3.84 cm, respectively; p < 0.0005). The operative time was shorter in TAH than in LH (2.22 ± 0.93 vs 2.43 ± 0.94, respectively; p = NS). The blood loss was less in the LH group than the TAH group (258.54 ± 65.26 vs 370.32 ± 74.8, respectively; p = NS). There were no significant differences between both groups regarding rates intraoperative and early postoperative complications; however, late postoperative complications were significantly higher in the TAH group (p < 0.05). The length of hospital stay was shorter with LH than TAH (3.63 ± 1.28 vs 5.22 ± 4 days, respectively; p < 0.001)ConclusionLH compares to TAH in terms of duration of surgery, rates of intraoperative and early postoperative complications, and the need for blood transfusion. However, it has significantly less rate of late postoperative complications and length of hospital stay.

Laparoscopic Hysterectomy for Benign Pathology Does Not Yield More Perioperative Complications than Abdominal or Vaginal Hysterectomies: Our Experience in Introducing Laparoscopic Hysterectomy.

Objectives:Total laparoscopic hysterectomy (TLH) is increasing as a substitute for total abdominal hysterectomy (TAH) and total vaginal hysterectomy (TVH) with the growing prevalence of laparoscopic surgery. The aim of this study is to assess perioperative complications of the chosen hysterectomy techniques performed for benign indications when started performing TLH. This was retrospective cohort study. This study was conducted at Nagahama City Hospital.Materials and Methods:There were 176 patients who underwent hysterectomy for benign indications from 2013 to 2016. Perioperative and postoperative outcomes were compared for the three different hysterectomy approaches laparoscopic; abdominal; and vaginal. Data were analyzed using the t-test or Chi-square and Fisher's exact test.Results:TAH, TLH, and TVH were performed on 118 patients (67.0%), 32 (18.2%), and 26 (14.8%), respectively. Operation time was significantly longer for the TLH group than for the TAH and TVH groups. Blood loss was lower for the TVH and TLH groups than for the TAH group. Three days after surgery, C-reactive protein was lower in the TVH group than in the TAH group. The average uterus size in the TAH group was larger than in the TVH and TLH groups. Patients undergoing TLH experienced fewer perioperative complications than patients in the TAH and TVH groups; however, this difference was not statistically significant.Conclusion:TLH for benign pathology does not yield more perioperative complications than TAH or TVH. However, vaginal hysterectomy is the least invasive approach. The final choice for the route of hysterectomy depends on many factors, including body mass index, uterus size, and experience of the gynecologist.

Does minimally invasive surgery reduce anxiety?

Objective:To evaluate whether there were any differences in preoperative and postoperative anxiety in patients who underwent total laparoscopic hysterectomy (TLH) (n=37) and total abdominal hysterectomy (TAH) (n=37).Material and Methods:All premenopausal patients who underwent TLH or TAH because of benign uterine disorders were enrolled. Anxiety status was assessed 6 hours before and after the operation using standardized validated questionnaires: State-Trait Anxiety Inventory.Results:In the TAH group, the state anxiety level of the patients significantly increased, whereas there was a significant decrease in the TLH group. For the trait anxiety level, there was a statistically significant increase in the TAH group postoperatively. In the TLH group, trait anxiety levels decreased postoperatively. In the analysis of between-group differences, pre and postoperative the state anxiety level was higher in the TAH group. A statistically significant difference was determined between the groups in respect of the postoperative state anxiety levels (p<0.05), but not in the preoperative state anxiety levels (p>0.05). Statistically significant differences were determined between the groups in respect of education, occupation, and curettage rates (p<0.05).Conclusion:Women undergoing TLH for benign uterine disease may have lower levels of preoperative and postoperative anxiety than women undergoing TAH.

Comparison of Different Surgical Approaches for Hysterectomy: A Single-Institution Experience

Objective: We aimed to compare surgical outcomes and postoperative complications among different hysterectomy approaches such as total abdominal hysterectomy, vaginal hysterectomy, multiport access laparoscopic hysterectomy, and single-port access laparoscopic hysterectomy.Study Design: This retrospective, single institution, case control study was carried out at the Obstetrics and Gynecology Department of Baskent University in Ankara, Turkey. We evaluated 86 consecutive patients who underwent hysterectomy for benign gynecological conditions.Results: A total of 86 women underwent hysterectomy: 20 (23.3%) total abdominal hysterectomy, 20 (23.3%) vaginal hysterectomy, 27 (31.3%) multiport access laparoscopic hysterectomy, and 19 (22.1%) single-port access laparoscopic hysterectomy using a transumbilical single-port system. There was no significant difference in uterine size between groups (Z=5.705; p=0.127). A statistically significant (p&lt;0.001) difference in operation time (duration of surgery) was observed among the following groups. The duration of surgery for the multiport access laparoscopic hysterectomy, and single-port access laparoscopic hysterectomy groups was similar, with these two laparoscopic procedures requiring significantly more time than total abdominal hysterectomy and vaginal hysterectomy procedures. There was no statistically significant difference in between hemoglobin levels before and after operation between groups. There was no statistically significant difference between groups in intraoperative and postoperative complications. Six patients experienced complications, one intraoperative and five postoperative. Intraoperative complication was ureter injury in single-port access laparoscopic hysterectomy group. The postoperative complication rate was 5.8% (5 cases) in 86 patients. Perirectal abscess in one patient and wound infection in two patients occurred in total abdominal hysterectomy group (15%). Urinary tract infection in one patient and vaginal cuff cellulitis in one patient occurred in vaginal hysterectomy group (4%). No complications were reported in multiport access laparoscopic hysterectomy, and single-port access laparoscopic hysterectomy groups. Post-surgery, all patients who underwent single-port access laparoscopic hysterectomy reported that they were satisfied with their incision and cosmetic results.Conclusions: When technically feasible, multiport access laparoscopic hysterectomy, and single-port access laparoscopic hysterectomy may be performed instead f total abdominal hysterectomy because of rapid recovery and shorter hospitalization however there are longer operating time.