Total Laparoscopic Hysterectomy Group Research Articles

Natural Orifice Transluminal Endoscopic Surgery-assisted Vaginal Hysterectomy versus Total Laparoscopic Hysterectomy: A Single-center Retrospective Study Using Propensity Score Analysis.

Objectives:The aim of this study is to evaluate the safety and efficacy of natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy (NOTES-AVH) compared with total laparoscopic hysterectomy (TLH).Materials and Methods:The population was a cohort of women who underwent NOTES-AVH and TLH for a nonprolapsed uterus and benign gynecological disease between October 2015 and December 2017 at Rajavithi Hospital, Thailand. Study outcomes included operative time, the requirement of blood transfusion, perioperative complications, and postoperative pain. Factors applied for propensity score matching included age, body mass index, parity, underlying disease, previous abdominal surgery, preoperative diagnosis, presence of endometriosis, and uterine weight. Mean difference (MD) and risk ratio with 95% confidence interval (CI) were calculated to represent relative measures of the comparison.Results:Among the 50 pairs, there were no differences in operative time (MD 15.9 min; 95% CI − 9.3–41.1), intraoperative complications (relative risk [RR] 0.33; 95% CI 0.04–3.10) or requirement of blood transfusion (RR 1.50; 95% CI 0.26–8.60) between the NOTES-AVH and TLH groups. NOTES-AVH was associated with lower intensity of postoperative pain (MD − 1.5 at 6-h; 95% CI − 0.8–2.2 and MD − 1.0 at 24-h; 95% CI − 0.4–−1.6) and shorter length of stay (MD − 0.3 day; 95% CI − 0.1–0.7 day).Conclusion:NOTES-AVH was safe and feasible for an alternative approach for hysterectomy. This technique was superior to TLH in that no abdominal incision was required, and postoperative pain was less intense.

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.

A Comparative Study of Non-descent Vaginal Hysterectomy and Laparoscopic Hysterectomy.

To compare intra- and post-op complications between non-descent vaginal hysterectomy and laparoscopic hysterectomy and establish the better method for hysterectomy in non-descent uterus. A prospective comparative study of 80 hysterectomies was done over a period of January 2017-Dec 2017, with 40 cases each in one group of non-descent vaginal hysterectomy (NDVH) and other group of total laparoscopic hysterectomy (TLH). Demographic characteristics, co-morbid conditions, indications for surgery, operative time, intra-operative blood loss, post-operative analgesia requirements, post-operative hospital stay and post-operative complications were compared between both groups. The most common age in both groups was 41-50years. Fibroid uterus was the most common indication for surgery in both groups. The mean operative time in NDVH group was 40min while it was 120min in TLH group, and the mean blood loss in NDVH group was 50ml, while it was 120ml in TLH group. P < 0.001 when intraoperative blood loss and operative time were compared between both groups. There were no conversions to laparotomy in NDVH group, while there were three conversions to laparotomy in TLH group. Both groups were similar in post-operative analgesia requirement and post-operative hospital stay. Post-operative complications were similar in both groups. Non-descent vaginal hysterectomy has advantage over laparoscopic hysterectomy as scarless surgery with fewer complications.

Comparison of Total Laparoscopic Hysterectomy with Abdominal Total Hysterectomy in Patients with Benign Disease: A Retrospective Cohort Study.

The present study aimed to determine whether total laparoscopic hysterectomy (TLH) is being implemented safely and appropriately compared with abdominal total hysterectomy (ATH) in our hospital. We retrospectively reviewed clinical records of 102 patients who underwent total hysterectomy for benign gynecological disease at Japanese Red Cross Yamaguchi Hospital from January 2017 to August 2018. We examined periods of hospital stay, operation time, blood loss, weight of the uterus, frequency of perioperative complications, and the duration from the first visit to the date of surgery. P < 0.05 was considered to be statistically significant indicated statistical significance. TLH and ATH were performed in 55 (53%) and 47 (46%) cases, respectively. The TLH group had significantly longer total operation time [133 (82-205) min vs. 87 (57-155) min, P < 0.0001], lesser blood loss [5 (5-35) g vs. 100 (10-820) g, P < 0.0001], shorter hospital stay [7 (5-14) days vs. 10 (9-26) days, P < 0.0001], and lighter uterine weight [206 (27-658) g vs. 554 (79-2284) g, P < 0.0001] than the ATH group. The frequency of perioperative complications did not differ between the two groups (3.5% vs. 8.0%, P = 0.4103). TLH had a longer operation time and a lesser excised uterine weight, but it had less intraoperative blood loss, shorter hospital stay, and no difference in perioperative complication frequency when compared with ATH.

Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day-care procedure: arandomised controlled trial.

To compare hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) versus total laparoscopic hysterectomy (TLH) as a day-care procedure. Parallel group, 1:1 randomised single-centre single-blinded trial, designed as a non-inferiority study with a margin of 15%. Belgian teaching hospital. Women aged 18-70years scheduled to undergo hysterectomy for benign indications. Randomisation to TLH (control group) or vNOTES (experimental group). Stratification according to uterine volume. Blinding of participants and outcome assessors. The primary outcome was hysterectomy by the allocated technique. We measured the proportion of women leaving within 12hours after hysterectomy and the length of hospital stay as secondary outcomes. We randomly assigned 70 women to vNOTES (n=35) or TLH (n=35). The primary endpoint was always reached in both groups: there were no conversions. We performed a sensitivity analysis for the primary outcome, assuming one conversion in the vNOTES group and no conversions in the TLH group: the one-sided 95% upper limit for the differences in proportions of conversion was estimated as 7.5%, which is below the predefined non-inferiority margin. More women left the hospital within 12hours after surgery after vNOTES: 77 versus 43%, difference 34% (95% CI 13-56%), P=0.007. The hospital stay was shorter after vNOTES: 0.8 versus 1.3days, mean difference -0.5days, (95% CI -0.98 to -0.02), P=0.004. vNOTES is non-inferior to TLH for successfully performing hysterectomy without conversion. Compared with TLH, vNOTES may allow more women to be treated in a day-care setting. RCT: vNOTES is just as good as laparoscopy for successful hysterectomy without conversion but allows more day-care surgery.

A comparison of pelvic organ prolapse and sexual function after abdominal and laparoscopic hysterectomy

Hysterectomy is one of the risk factors of pelvic organ prolapse (POP). There is no consensus on whether the route of hysterectomy affects the subsequent development of POP. The aim of the study was to assess POP and sexual function 1 year after a hysterectomy when comparing total abdominal hysterectomy (TAH) with total laparoscopic hysterectomy (TLH). The study applied the pelvic organ prolapse quantification (POP-Q) as the measure of POP and a short-form of the POP/Urinary Incontinence Sexual Function Questionnaire (PISQ-12). All patients that underwent either TAH or TLH due to benign causes between March 2016 and March 2017 at the tertiary hospital used for the study were included in our prospective cohort study. POP-Q measurements and PISQ-12 scores were assessed 1 year postoperatively. We included 182 patients in the clinical examinations. There were no statistically significant differences in demographic characteristics between the TAH and TLH groups. Also, there we no differences observed in the objective POP measurements between the two study groups. Results of the two groups' PISQ-12 scores were also similar. However, postoperative vaginal lengths were found to be significantly shorter in the patients who had undergone TAH compared with those who had undergone TLH. TAH and TLH are comparable regarding short-term objective pelvic organ prolapse. Although we found statistically a significant difference in vaginal lengths between the two groups, no clinical significance was found in terms of sexual function.

Comparison of 30-day Complication Rates between Laparoscopic Myomectomy and Total Laparoscopic Hysterectomy for the Treatment of Uterine Leiomyoma in Women Older Than Age 40

To evaluate whether there are differences in complication rates between laparoscopic myomectomy (LM) and total laparoscopic hysterectomy (TLH) for the treatment of uterine leiomyoma in perimenopausal women. A retrospective cohort study using 1:2 propensity score matching (Canadian Task Force classification II-2). American College of Surgeons National Surgical Quality Improvement Program database. Women between the ages of 40 and 60 years undergoing surgical laparoscopic surgery for uterine leiomyoma between the years 2010 and 2016. Women were stratified to either LM or TLH at a ratio of 1:2 using propensity score matching. Descriptive statistics were reported as means with standard deviations. Pairwise analysis using the Student t test and chi-square test was performed where appropriate. Multivariable logistic regression was used to identify factors associated with the presence of a complication. After propensity score matching, there were 631 myomectomies and 1262 hysterectomies. The operating time was slightly longer for LM compared with TLH (166.8 ± 90.3 minutes vs 157.9 ± 70.9 minutes, p = .03). The overall complication rate was 6.3%. There were no differences in complications between the LM and TLH groups (5.9% vs 6.6%, p = .54). Urinary tract infections were more common in the TLH group (2.3% vs 0.6%, p = .01). There were no other differences in the rates of specific complications between the 2 groups. On logistic regression, wound class greater than 3 was most strongly associated with a risk of complications (adjusted odds ratio [aOR] = 8.89; 95% confidence interval [CI], 1.28-15.87). Other variables associated with an increased risk of complications were conversion to hysterectomy (aOR = 5.91; 95% CI, 1.7-9.63), total operating time (aOR = 1.05; 95% CI, 1.02-1.07), and length of stay over 1 day (aOR = 3.67; 95% CI, 2.31-5.8). LM is not associated with an increased risk of complications compared with TLH in women over the age of 40 years undergoing treatment for uterine leiomyomata.

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.

Outcomes in women undergoing robotic-assisted laparoscopic hysterectomy compared to conventional laparoscopic hysterectomy at a tertiary hospital in Western Australia.

Robotic-assisted laparoscopic hysterectomy (RALH) is associated with improved outcomes compared to open surgery in patients with endometrial cancer but data are conflicting when comparing RALH to conventional total laparoscopic hysterectomy (TLH). In October 2014, a RALH program was established in Perth, Western Australia. To compare outcomes in patients undergoing RALH with a matched cohort undergoing TLH. A retrospective matched cohort study compared outcomes in 45 patients who underwent RALH with 45 controls who were patients treated with TLH. Mean operating time was longer in the RALH group compared to controls (75.42min vs 53.18min, mean difference 22.24min, P <0.001, 95% Cl, 11.07-33.42). No differences were observed in mean pain scores (RALH 1.47 vs TLH 1.84 P=0.31), mean parenteral and oral opioid use (RALH 14.3mg and 42.4mg vs TLH 17.5mg and 52.57mg, P= 0.42 and 0.42, respectively), and mean length of stay (RALH 1.51 vs TLH 1.67days, P=0.49). Two patients in the RALH group and one patient in the TLH group sustained iatrogenic bladder injuries (P=0.62). The establishment of the RALH program at our institution appeared to be associated with equivalent morbidity, post-operative pain, opioid use and length of stay compared to conventional laparoscopy. A surgical learning curve for RALH was observed. Well-designed prospective studies are needed to further evaluate short- and long-term patient function, morbidity, quality of life and oncologic outcomes.

Perioperative surgical outcome of conventional and robot-assisted total laparoscopic hysterectomy

BackgroundTo evaluate surgical outcome in a consecutive series of patients with conventional and robot assisted total laparoscopic hysterectomy.MethodsA retrospective cohort study was performed among patients with benign and malignant indications for a laparoscopic hysterectomy. Main surgical outcomes were operation room time and skin to skin operating time, complications, conversions, rehospitalisation and reoperation, estimated blood loss and length of hospital stay.ResultsA total of 294 patients were evaluated: 123 in the conventional total laparoscopic hysterectomy (TLH) group and 171 in the robot TLH group. After correction for differences in basic demographics with a multivariate linear regression analysis, the skin to skin operating time was a significant 18 minutes shorter in robot assisted TLH compared to conventional TLH (robot assisted TLH 92m, conventional TLH 110m, p0.001). The presence or absence of previous abdominal surgery had a significant influence on the skin to skin operating time as did the body mass index and the weight of the uterus.Complications were not significantly different. The robot TLH group had significantly less blood loss and lower rehospitalisation and reoperation rates.ConclusionsThis study compares conventional TLH with robot assisted TLH and shows shorter operating times, less blood loss and lower rehospitalisation and reoperation rates in the robot TLH group.

Laparoscopic Supracervical Hysterectomy and Laparoscopic Total Hysterectomy in Patients with Very Large Uteri: a Retrospective Single-Center Experience at a Major University Hospital.

Objective The main objectives of our study were to demonstrate that laparoscopic supracervical hysterectomy (LSH) or total laparoscopic hysterectomy (TLH) can be performed safely even in patients with a uterine weight ≥ 500 g, to analyze the rate of conversions to laparotomy due to uterine size and to estimate the incidence and type of intraoperative and long-term postoperative complications. Study Design Retrospective open, single-center, comparative interventional study of LSH and TLH. Results The present study comprised a total of 138 patients that underwent laparoscopic hysterectomy with a uterine weight ≥ 500 g; 109 patients (79.0 %) underwent LSH and 29 patients (21.0 %) underwent TLH. Median uterine weight across the entire cohort was 602 g, with the largest uterus weighing 1860 g. A total of 24 cases (17.4 %) among the 138 hysterectomies were converted to a laparotomy due to lack of adequate intraabdominal space and size of the uterus. Mean uterine weight of the patients in the LSH group that underwent conversion was 883 g (SD 380 g, n = 13) and 757 g (SD 371 g, n = 11) in the TLH group. The rate of conversion to laparotomy due to the uterine weight was significantly lower in the LSH group (11.9 %) compared to the TLH group (37.9 %) (p = 0.002). Intraoperative complications requiring laparotomy for other reasons but uterine size occurred in 6 patients of the study cohort (6/138; 4.3 %). Long-term postoperative complications occurred in 2 patients (2/138, 1.4 %), both patients from LSH group had to be re-operated on due to adhesions. Conclusions Our study adds further insight in the limited data set of laparoscopic hysterectomy for increased uterine weight and shows that LSH and TLH are safe and feasible even in patients with very large uteri (≥ 500 g).

Effect of Total Laparoscopic Hysterectomy vs Total Abdominal Hysterectomy on Disease-Free Survival Among Women With Stage I Endometrial Cancer

Standard treatment for endometrial cancer involves removal of the uterus, tubes, ovaries, and lymph nodes. Few randomized trials have compared disease-free survival outcomes for surgical approaches. To investigate whether total laparoscopic hysterectomy (TLH) is equivalent to total abdominal hysterectomy (TAH) in women with treatment-naive endometrial cancer. The Laparoscopic Approach to Cancer of the Endometrium (LACE) trial was a multinational, randomized equivalence trial conducted between October 7, 2005, and June 30, 2010, in which 27 surgeons from 20 tertiary gynecological cancer centers in Australia, New Zealand, and Hong Kong randomized 760 women with stage I endometrioid endometrial cancer to either TLH or TAH. Follow-up ended on March 3, 2016. Patients were randomly assigned to undergo TAH (n = 353) or TLH (n = 407). The primary outcome was disease-free survival, which was measured as the interval between surgery and the date of first recurrence, including disease progression or the development of a new primary cancer or death assessed at 4.5 years after randomization. The prespecified equivalence margin was 7% or less. Secondary outcomes included recurrence of endometrial cancer and overall survival. Patients were followed up for a median of 4.5 years. Of 760 patients who were randomized (mean age, 63 years), 679 (89%) completed the trial. At 4.5 years of follow-up, disease-free survival was 81.3% in the TAH group and 81.6% in the TLH group. The disease-free survival rate difference was 0.3% (favoring TLH; 95% CI, -5.5% to 6.1%; P = .007), meeting criteria for equivalence. There was no statistically significant between-group difference in recurrence of endometrial cancer (28/353 in TAH group [7.9%] vs 33/407 in TLH group [8.1%]; risk difference, 0.2% [95% CI, -3.7% to 4.0%]; P = .93) or in overall survival (24/353 in TAH group [6.8%] vs 30/407 in TLH group [7.4%]; risk difference, 0.6% [95% CI, -3.0% to 4.2%]; P = .76). Among women with stage I endometrial cancer, the use of total abdominal hysterectomy compared with total laparoscopic hysterectomy resulted in equivalent disease-free survival at 4.5 years and no difference in overall survival. These findings support the use of laparoscopic hysterectomy for women with stage I endometrial cancer. clinicaltrials.gov Identifier: NCT00096408; Australian New Zealand Clinical Trials Registry: CTRN12606000261516.

Evaluation of quality of life and cost-effectiveness of definitive surgery and the levonorgestrel intrauterine system as treatment options for heavy menstrual bleeding.

This study aimed to compare the levonorgestrel intrauterine system (LNG-IUS) with abdominal hysterectomy (TAH) and total laparoscopic hysterectomy (TLH) as first-line treatments for heavy menstrual bleeding (HMB). Ninety-eight patients aged 20-55 years who complained of regular heavy menstrual bleeding were enrolled in the study. The TAH group included 29 patients, the LNG-IUS group included 34, and the TLH group included 35. These groups were compared in terms of quality of life and the cost-effectiveness of the selected methods. Quality of life was assessed using the 36-Item Short Form (SF-36), and cost-effectiveness was assessed according to the current cost of each approach. The quality of life parameters, with the exception of mental health, improved significantly in the LNG-IUS, TAH, and TLH groups. The mean costs of the LNG-IUS, TAH, and TLH procedures were $99.15 ± 4.90, $538.82 ± 193.00 and $1617.05 ± 258.44, respectively (P < 0.05). Overall, LNG-IUS was the most cost-effective treatment option. The outcome measures of the SF-36 revealed that after 6 months, these treatments were equal in terms of quality of life, except for mental health. LNG-IUS was the most cost-effective approach.

Total Laparoscopic Hysterectomy versus Total Abdominal Hysterectomy in the Treatment of Benign Gynaecological Disease: A Retrospective Review Over 5 Years

Hysterectomy remains one of the most common gynaecological procedures performed in the UK. However, unlike other parts of Europe and America, where laparoscopic hysterectomy (LH) rates have significantly increased, in the UK, abdominal hysterectomy (AH) rates remain high and often the first choice for many surgeons. The minimal access route offers significant patient benefits over open surgery, and the purpose of this study was to evaluate the role of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) in the management of benign gynaecological conditions. This retrospective study was carried out over a 5-year period, and 296 procedures were included. Outcome measures included operating time, estimated blood loss (EBL), intraoperative and postoperative complications, postoperative analgesia requirements and length of hospital stay. TLH was associated with a significantly lower mean operating time (63.4 versus 75.3 min, P = <0.001) and reduced EBL (145.1 versus 277.0 ml, P = <0.001). Intraoperative complications were significantly less in the TLH group (1.9 versus 7.0 %, P = 0.029) with no ureteric injuries noted. Postoperative complications were also lower (6.8 versus 15.6 %, P = 0.016). TLH was also associated with significantly less analgesia requirements, with fewer requiring breakthrough analgesia (6.2 versus 26.6 %, P = <0.001), and a significantly shorter inpatient hospital stay (1.7 versus 3.0 days, P = <0.001). The results from our study highlight that TLH is superior to TAH in all operative outcome measures. With adequate training and experience, TLH is a safe, reproducible technique that should be offered to all women requiring a hysterectomy for a normal sized uterus in the absence of significant adhesions.

Hysterectomy for Large Sized Uteri with Benign Pathology: Total Laparoscopic or Vaginal Hysterectomy Using Blood Vessel Sealing Systems? Analysis of 514 Patients

Objective: The goal of this research was to compare surgical outcomes of vaginal hysterectomy (VH), using a bipolar vessel sealing system (BVSS; Ligasure,® Valleylab, Boulder, CO), with total laparoscopic hysterectomy (TLH) for patients with large uteri. Materials and Methods:Design: This was a dual-center, retrospective analysis (Canadian Task-force Classification II −3) that took place in two tertiary-care hospitals. Patients: Reviews were performed on hospital records of women with large uteri (uterine weight ≥500 g) who underwent VH or TLH for benign indications between the years 2003 and 2011. Evaluations were conducted on a total of 1988 VH cases, using BVSS, performed in the Minimally Invasive Gynecological Surgery Unit of Valdese Hospital, in Turin, Italy, and 1529 TLH cases, in the department of Obstetrics and Gynecology of the Sacred Heart Hospital, in Negrar, Italy. Data for patients' demographics, indications for surgery, patient histories with respect to previous surgeries, duration of surgeries, blood loss, perioperative complications, and length of in-patient stays were collected from the medical records. Exclusion criteria were: coexistence of uterine, cervical, or ovarian malignancy; uterine-vaginal prolapse; reconstructive pelvic surgery; and associated or other concurrent procedures. Intervention: The intervention analyzed was VH using a Ligasure BVSS and TLH. Results: The two groups were homogenous with respect to demographic data and indications for surgery. The groups were significantly different for mean operative time (VH: 74.7 ± 34 versus TLH: 139.4 ± 57 minutes; p < 0.005); mean hospital stay (VH: 1.5 ± 1.1 versus TLH: 2.8 ± 1.6 days; p < 0.05); mean blood loss (TLH: 184.6 ± 211.3 mL versus VH: 478 ± 627.4 mL; p < 0.005). The overall complication rates were 16.25% in the VH versus 10.61% in the TLH group (p = 0.003). Conclusions: In expert hands, both techniques seem to be feasible and relatively safe for enlarged uteri. VH using BVSS results in reduced operative time and hospital stay. Total laparoscopic hysterectomy results in lower blood loss and a lower incidence of perioperative complications, compared with VH, using BVSS. (J GYNECOL SURG 32:324)

Total laparoscopic hysterectomy versus total abdominal hysterectomy in the treatment of benign gynaecological disease: a retrospective review over 5 years

Hysterectomy remains one of the most common gynaecological procedures performed in the UK. However, unlike other parts of Europe and America, where laparoscopic hysterectomy (LH) rates have significantly increased, in the UK, abdominal hysterectomy (AH) rates remain high and often the first choice for many surgeons. The minimal access route offers significant patient benefits over open surgery, and the purpose of this study was to evaluate the role of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) in the management of benign gynaecological conditions. This retrospective study was carried out over a 5-year period, and 296 procedures were included. Outcome measures included operating time, estimated blood loss (EBL), intraoperative and postoperative complications, postoperative analgesia requirements and length of hospital stay. TLH was associated with a significantly lower mean operating time (63.4 versus 75.3 min, P = <0.001) and reduced EBL (145.1 versus 277.0 ml, P = <0.001). Intraoperative complications were significantly less in the TLH group (1.9 versus 7.0 %, P = 0.029) with no ureteric injuries noted. Postoperative complications were also lower (6.8 versus 15.6 %, P = 0.016). TLH was also associated with significantly less analgesia requirements, with fewer requiring breakthrough analgesia (6.2 versus 26.6 %, P = <0.001), and a significantly shorter inpatient hospital stay (1.7 versus 3.0 days, P = <0.001). The results from our study highlight that TLH is superior to TAH in all operative outcome measures. With adequate training and experience, TLH is a safe, reproducible technique that should be offered to all women requiring a hysterectomy for a normal sized uterus in the absence of significant adhesions.

Feasibility of prophylactic laparoscopic appendectomy in obese patients

Purpose: To investigate the feasibility of prophylactic laparoscopic appendectomy in obese patients. Materials and Methods: A retrospective study was performed in obese patients undergoing total laparoscopic hysterectomy (TLH) along (66 patients, TLH group) or in combination (55 patients, THL+LA group) with laparoscopic appendectomy (LA) between 2007 and 2012. Operation time, intraoperative bleeding volume, postoperative exhaust time, analgesic use, and the incidence of major complications, hospital stay and cost of hospitalization were compared. Results: The operation time was longer in THL+LA group than in TLH group (p Conclusion: It is safe and feasible for obese patients to undergo simultaneous LA and prophylactic appendectomy, and the combined procedure does not increase the risk of infection of hysterectomy and avoids reoperation of patients due to the recurrence of appendicitis.

Surgical and oncological outcome of laparoscopic surgery, compared to laparotomy, for Japanese patients with endometrial cancer

Abstract Study objective The purpose of this study was to elucidate the surgical and oncological outcomes after laparoscopic surgery for endometrial cancer at our hospital. Materials and methods Surgical outcomes, complications rates, 2-year survival rates, and recurrence rates were evaluated in 44 patients who underwent total laparoscopic hysterectomy (TLH) and 57 patients who underwent total abdominal hysterectomy (TAH) for endometrial cancer at our hospital between August 2010 and November 2013. Results There was no significant difference between the two groups with respect to age or body mass index. More than 80% of patients in both groups had stage I cancer. In the TLH group, the histological types were endometrioid adenocarcinoma in 42 of 44 patients, carcinosarcoma in one patient, and serous adenocarcinoma in one patient. Operative times were significantly longer in the TLH group, but patients in this group had less intraoperative blood loss, shorter hospital stays, and reduced levels of postoperative pain, compared to patients in the TAH group. There were four cases of postoperative infection and one case of vessel injury in the TLH group. No patient in this group required blood transfusion or conversion to open surgery. There were recurrences in two (4.7%) patients in the TLH group (i.e., carcinosarcoma and serous adenocarcinoma) and in five (8.6%) patients in the TAH group. Conclusion Laparoscopic surgery is safe and feasible for patients with early-stage endometrial cancer. However, patients with carcinosarcoma and other histologic types of endometrioid adenocarcinoma require special attention because of the high risk of recurrence and poor prognosis.

Uterine Sarcomas in Patients Undergoing Surgery for Presumed Leiomyomas: 10 Years' Experience

Study ObjectiveTo find the incidence of sarcomas in patients undergoing surgery for presumed leiomyomas. DesignRetrospective study (Canadian Task Force classification II-3). SettingPaul's Hospital, Centre for Advanced Laparoscopy and Infertility, Kochi, India. PatientsAll women who underwent total laparoscopic hysterectomy (TLH), laparoscopic myomectomy (LM), and hysteroscopic myomectomy (HM) at Paul's Hospital for presumed leiomyomas from January 1, 2004 to December 31, 2014 that were then diagnosed as sarcomas on histopathologic examination. InterventionsTLH, LM, and HM. Measurements and Main ResultsA total of 2678 patients underwent TLH, LM, and HM at Paul's Hospital for presumed leiomyomas from January 1, 2004 to December 31, 2014. Five patients were diagnosed as leiomyosarcoma and 3 patients as endometrial stromal sarcoma on histopathologic examination. Women's ages ranged from 12 to 53 years. Histopathologic diagnosis of leiomyosarcoma was made in 3 patients from the TLH group and 2 patients from the myomectomy group. Two patients from the TLH group and 1 patient from the myomectomy group were diagnosed as endometrial stromal sarcoma on histopathologic examination. The incidence of uterine sarcomas (leiomyosarcoma and endometrial stromal sarcoma) in patients undergoing surgery for presumed leiomyomas was found to be .29% (1 in 335 patients) in our study. ConclusionOver a period of 10 years (2004–2014), the incidence of uterine sarcomas in patients undergoing surgery for presumed leiomyomas was found to be .29% in our study.

Risks and Benefits of Total Laparoscopic Hysterectomy and the Effect of Learning Curve on Them.

The objective of this study was to prospectively analyze the risks and benefits of total laparoscopic hysterectomy (TLH) compared with total abdominal hysterectomy (TAH) and the effects of learning curve on them over 4years (March 2010-April 2014). It was a prospective randomized study. The study was conducted in Delhi government hospital which had no staff with previous experience of advanced laparoscopic surgeries. Two hundred fifty patients were operated on for benign gynecological conditions (35-65years). The numbers of cases operated laparoscopically were as follows-22 in 2010, 25 in 2011, 32 in 2012, and 46 in 2013. Equal number. of patients operated by open surgery were taken in the study during the same time period. Two hundred fifty cases were operated since March 2010, by either laparoscopic or open surgery. Incidence of major complications was-1.6% for TLH compared to 4% in TAH. After the first year of surgery, this incidence has fallen to 0% in subsequent years in TLH group. The incidence of minor complications declined from 14 to 4.5% in the third year of study. Total rate of conversion to laparotomy was 9.7%, which again had a significant decline after the first year. TLH also clearly showed superior benefits of less intraoperative blood loss, early postoperative ambulance, and shorter period of hospital stay in comparison with TAH. The study has led us to conclude that TLH is a safe, effective, and reproducible technique after the completion of a period of training necessary to standardize the procedure. This approach must be established in our real, day-to-day clinical practice.