Total Laparoscopic Hysterectomy Group Research Articles

Total laparoscopic hysterectomy, vaginal hysterectomy and total abdominal hysterectomy using electrosurgical bipolar vessel sealing technique: a randomized controlled trial.

To compare total laparoscopic hysterectomy (TLH), total abdominal hysterectomy (TAH) and vaginal hysterectomy (VH) using electrosurgical bipolar vessel sealing (EBVS) technique regarding operative time, intra and postoperative complications. The current prospective randomized controlled clinical trial was conducted at Ain-shams University maternity Hospital, Cairo, Egypt. Ninety patients who were admitted from gynecologic outpatient clinic to undergo hysterectomy were enrolled. The study population was randomized according to type of hysterectomy done into 3 groups: group 1: VH; group 2: AH and group 3: TLH. EBVS was used in all groups. Three staff members' surgeons were also randomized to operate on the patients and they were all equally competent in all the procedures. Main outcome measures were operative time, operative blood loss, operative complications, postoperative pain assessment using the visual analogue scale (0-10), and the need for analgesics as well as the postoperative hospital stay. Ninety patients were randomized to undergo VH, TAH or TLH for benign pathology using EBVS. Postoperative pain score and the need for analgesia were least in TLH compared to the other two groups, (p < 0.001). The hospital stay in TLH group was shorter than the other two groups, but there was no significant difference between VH group and TAH group with regard to hospital stay, (p < 0.001). The total operative time was shortest in the VH group (100.4 ± 35.8 min) compared to TLH (126 ± 42.7 min) and TAH (123.6 ± 44.5 min) (p = 0.033). The operative complications were more with VH and TAH groups. The blood loss was more with VH (p = 0.039). TLH had a longer operation time, yet, less blood loss, shorter hospital stay, less postoperative pain and fewer complications, compared to TAH and VH using EBVS.

Uterine artery ligation at the beginning of total laparoscopic hysterectomy reduces total blood loss and operation duration

The purpose of this study was to compare the feasibility, blood loss, duration of surgery and complications between patients in whom both uterine arteries were ligated by surgical clips and cut using a 5-mm ligature at the beginning of total laparoscopic hysterectomy (TLH) and patients in whom uterine arteries were not ligated at the beginning of TLH. In our prospective study, a total of 60 women underwent TLH. Uterine artery ligation (UAL) was done at the beginning of the procedure. Women were divided into TLH + UAL (n = 30) and TLH (n = 30) groups. In TLH group, TLH was done without ligating the uterine arteries at the beginning of the procedure. In TLH + UAL group, TLH was done with ligation of both uterine arteries at the beginning of the procedure. The mean operating time was longer for the TLH group (99.16 ± 7.01) than TLH + UAL group (63.27 ± 7.16). The median total blood loss was higher in TLH group (109.38 ± 33.03 mL) than TLH + UAL group (47.50 ± 8.12 mL). UAL at the beginning of TLH is a technically feasible procedure. It reduces the total blood loss and decreases the time taken for the procedure and length of hospital stay.

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.

Comparison between Laparoscopic Hysterectomy and Abdominal Hysterectomy

Aims: Hysterectomy can be performed by abdominal, vaginal and laparoscopic methods. Laparoscopic hysterectomy has been reported as an alternative to traditional abdominal hysterectomy with benefit of early recovery, short hospital stay and less operative complications. This study compared laparoscopic versus abdominal hysterectomy in terms of surgery time, blood loss, post-operative recovery, and duration of hospital stay. Methods: This is a retrospective comparative study among sixty patients who underwent laparoscopic or abdominal hysterectomy for various indications in the Department of Obstetrics and Gynaecology of the Third affiliated hospital of Zhengzhou University from January to March 2007. The data of the patients meeting the set criteria were obtained from the hospital records and hospital based computerized coding system. Enrolled cases were divided in two groups with thirty in each arm. Group TLH (total laparoscopic hysterectomy) was designated for patients who underwent total laparoscopic hysterectomy and group TAH (total abdominal hysterectomy) for those who underwent total abdominal hysterectomy. Results: There was comparatively less blood loss in TLH group (60.2±5.17 ml versus 75.7±7.12 ml) but it was statistically insignificant (p=0.12). The laparoscopic hysterectomy took longer time (107.6±32.4 min versus 74.9±31.1 min) than the abdominal (p&lt;0.001). There was early recovery among TLH group 1.6±0.6 days versus 2.1±0.5 days in TAH group (p=0.001). Mean duration of hospital stay was significantly shorter in TLH group 7.6±1.9 days versus 10.1±2.1 days in TAH group (p&lt;0.001). Conclusions: Laparoscopic hyserectomy is an effective alternative to abdominal hysterectomy with the advantage of less intra-operative blood loss, fast recovery and short hospital stay. DOI: http://dx.doi.org/10.3126/njog.v9i1.11183 NJOG 2014 Jan-Jun; 2(1):26-28

Effects of patient position on lower extremity venous pressure during different types of hysterectomy.

To explore the effects of different types of hysterectomy on lower extremity venous pressure. Ninety-nine patients with benign uterine diseases who were indicated for hysterectomy were included in the present prospective study. Patients were divided into three groups according to their preferences: (i) total laparoscopic hysterectomy (TLH) group (n = 36); (ii) transvaginal hysterectomy (TVH) group (n = 32); and (iii) transabdominal hysterectomy (TAH) group (n = 31). Lower extremity venous pressure was monitored using a pressure sensor during the surgery. Compared with the supine position (TAH group, lower extremity venous pressure of intraoperative 16.50 cmH2 O), lower extremity venous pressure of the improved lithotomy position (TLH group, lower extremity venous pressure of intraoperative 53.27 cmH2 O) and conventional lithotomy position (TVH group, lower extremity venous pressure of intraoperative 42.09 cmH2 O) were significantly increased (P < 0.01).Venous pressure was reduced when patients lowered their heads by 15° or 5° in modified or conventional lithotomy positions, respectively (P < 0.01). Venous pressure was increased significantly after the establishment of pneumoperitoneum in the TLH group (P < 0.01). Modified lithotomy position (TLH group) and conventional lithotomy position (TVH group) and CO2 pneumoperitoneum may result in increased lower extremity venous pressure during hysterectomy. Furthermore, elevated venous pressure can be altered by changing the intraoperative position. Specifically, intraoperative positioning of the lower extremities represents a modifiable risk factor for deep venous thrombosis.

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.

Introduction of Total Laparoscopic Hysterectomy as a Substitute for Laparoscopically Assisted Vaginal Hysterectomy: A Comparison of the First 23 Cases

There are two major procedures in simple laparoscopic hysterectomy, namely laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH). There are not so many reports in which LAVH and TLH have been compared directly. In our facility, LAVH had also been performed routinely for benign lesions. Recently, we have been attempting to introduce TLH to substitute LAVH. To examine whether introduction of TLH in a facility in which LAVH has been predominantly performed has any specific risks, the first 23 cases were retrospectively compared with LAVH procedures performed in the past. A total of 246 cases of LAVH performed in our facility from January 2007 to June 2013 were retrospectively compared with first 23 cases of TLH. The operative time was significantly longer in the TLH group. The estimated blood loss during surgery was also significantly lower in TLH group. Four cases required blood transfusions in the LAVH group, while no cases needed blood transfusions in the TLH group. Complications related to surgery occurred in 12 cases in the LAVH group: 3 cases of peritonitis, 2 cases of vaginal cuff bleeding, 3 cases of vaginal cuff abscess, 1 case of pulmonary thrombosis, 1 case of vesico-vaginal fistula, 1 case of ureteral injury and 1 case of intestinal herniation at port site. There were no complications in the TLH group. The length of hospital stay was not significantly different. As a conclusion, although there was significant bias in the case selection, it is feasible to introduce TLH safely in a facility which has sufficient experience of LAVH.

Evaluation of Uterine Volume in Total Laparoscopic Hysterectomy for Uterine Leiomyomas

Background: The aim of this retrospective study was to evaluate uterine volume in patients who underwent transabdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH) for uterine leiomyomas in our teaching hospital and to determine the appropriate uterine volume in patients who could undergo TLH. Methods: This retrospective study was based on a cohort 47 consecutive cases that underwent TLH for uterine leiomyomas in our institution between April 2008 and April 2012 (TLH group). Controls were defined as 134 patients who underwent TAH for uterine leiomyomas in our institution between April 2008 and April 2012 (TAH group). Results: The TLH group comprised 45 cases because two surgeries in the TLH group were converted to TAH. Uterine volume was significantly smaller in the TLH group than in the TAH group (median 342 g vs. 788 g). Surgical duration was significantly longer in the TLH group than in the TAH group (median 214 minutes vs. 152 minutes). Blood loss was significantly lower in the TLH group than in the TAH group (median 0 mL vs. 250 mL). The incidence of postoperative complications was lower in the TLH group than in the TAH group (0/45 vs. 15/134). The hospital stay was significantly shorter for the TLH group than for the TAH group. In the TLH group, surgical duration correlated with uterine volume (regression coefficient = 1.6598, P = 0.0 014). Conclusion: There seems to be no limitation of uterine volume in TLH for uterine leiomyomas because TLH is safer than TAH except for the longer surgical duration. doi: http://dx.doi.org/10.4021/jcgo179w

Secondary hemorrhage after different modes of hysterectomy

Secondary hemorrhage after hysterectomy is rare but a life-threatening complication. The aim of this study is to estimate the cumulative incidence, patient characteristics, and potential risk factors of secondary hemorrhage after abdominal, vaginal, and laparoscopic hysterectomies. We did a retrospective observational study in which 1,623 cases of total laparoscopic hysterectomy (TLH), 963 cases of total abdominal hysterectomy (TAH), and 1,171 cases of vaginal hysterectomy (VH) were analyzed. Of the total 37 hemorrhages following hysterectomies, 23 were after TLH, 8 following VH, and 6 were after TAH. The cumulative incidence of secondary hemorrhage after any type of total hysterectomies was 0.98 %. TLH was associated with the highest risk of secondary hemorrhage (1.51 %) followed by VH (0.68 %) and TAH group (0.62 %). The relative risk of secondary hemorrhage following TLH compared to TAH and VH were 2.3 and 2.1, respectively. Both were statistically significant. The average size of the uterus in the TLH group was 516.7 g, and in the TAH and VH group, it was 140 and 142.5 g, respectively, which was statistically significant. The median time interval between hysterectomy and secondary hemorrhage was 11 days in TAH and VH group and 13 days in TLH group. Our data suggest that secondary hemorrhage is rare but may occur more often after TLH than after other hysterectomy approaches. Whether it is related to the application of thermal energy to tissues which cause more tissue necrosis and devascularization than sharp colpotomies in the TAH and VH groups is unclear. Large size of uteri, excessive use of energy source for uterine artery, and colpotomy may play a role.

Surgical Outcome and Cost Comparison Between Total Vaginal Hysterectomy and Laparoscopic Hysterectomy for Uteri Weighing >500 g

Study ObjectiveTo compare surgical outcomes and overall costs of less invasive methods of hysterectomy to treat benign disease including total vaginal hysterectomy (TVH) and total laparoscopic hysterectomy (TLH) in women with a uterus weighing >500 g. DesignRetrospective review of medical records (Canadian Task Force classification III). SettingUniversity-associated hospital. PatientsOne hundred three women with a uterus weighing >500 g who had undergone either total vaginal hysterectomy (TVH) (n = 52) or total laparoscopic hysterectomy (TLH) (n = 51). Measurements and Main ResultsCost data were extracted from the hospital billing system. Patient characteristics, surgical outcomes, and hospital costs were compared between the 2 groups. Patient characteristics were similar in both groups except for a history of surgery (TVH 11.5%, and TLH 37.3%; p = .01). Insofar as surgical outcomes, mean (SD) operative time was shorter in the TVH group compared with the TLH group (110.00 [28.68] minutes vs 180.47 [51.32] minutes; p < .001), and hospital stay was longer (8.08 [0.68] days vs 7.45 [1.03] days; p < .001). Other surgical outcomes including estimated blood loss (p = .20) and decrease in hemoglobin (p = .12) did not differ between the 2 groups. Total hospital costs (converted from Korean won to US dollars) were significantly lower in the TVH group than in the TLH group ($2076.59 [$666.58] vs $2744.03 [$715.76]; p < .001). ConclusionOur data suggest that TVH is a safe and economic procedure even in women with a uterus weighing >500 g. Skilled surgeons should preferentially consider TVH for treatment of benign uterine disease, regardless of uterine size.

Systematic Implementation of Laparoscopic Hysterectomy Independent of Uterus Size: Clinical Effect

Study ObjectiveTo investigate the effect of uterine weight on the mode of hysterectomy and on perioperative outcomes and to explore how the increasing experience in endoscopic techniques influenced our choice of surgical approach to hysterectomy to treat benign conditions. DesignRetrospective analysis (Canadian Task Force classification II-2). SettingUniversity-based department of obstetrics and gynecology. PatientsA series of 1518 consecutive women with benign uterine conditions other than pelvic organ prolapse who underwent hysterectomy at our department between January 2000 and December 2011. InterventionsGradual implementation of the laparoscopic approach over years, with the goal of attempting endoscopic hysterectomy whenever possible and irrespective of uterine weight. Comparisons were made on the basis of various approaches to hysterectomy including vaginal hysterectomy (VH), abdominal hysterectomy (AH), and total laparoscopic hysterectomy (TLH) and on uterine weight. Measurements and Main ResultsHysterectomies performed included 568 VH (37.4%), 234 AH (15.4%), and 716 TLH (47.2%). Postoperative complications were lower in the TLH group vs the AH group; no significant difference was observed between the VH vs TLH groups or the AH vs VH groups. A marked reduction in the need for open surgery was noted between 2000 and 2011 (p for trend <.001). Restricting the analysis to TLH, an increase in operative time and blood loss was observed, parallel to increasing uterine weight. Hospital stay and rate of intraoperative and postoperative complications were independent of uterine weight. In 45 women with uterus weight ≥1000 g, the initial approach was via laparoscopy, with a success rate of 95.6% (n = 43). A marked tendency toward reduction in the use of open surgery was observed through the years when uterine weight was ≥1 kg (p for trend <.001). ConclusionSystematic implementation of laparoscopic hysterectomy enables a marked reduction in the need for AH. In experienced hands, even very large uteri (≥1 kg) can be safely removed via laparoscopy.

Preoperative assessment by magnetic resonance imaging is useful for planning the treatment of an enlarged uterus by total laparoscopic hysterectomy

The purpose of this study was to compare the intraoperative and postoperative parameters among the three approaches used to treat large uterine myomas: laparoscopic assisted vaginal hysterectomy (LAVH), total laparoscopic hysterectomy (TLH) and abdominal hysterectomy, and to evaluate the selection criteria for laparoscopic hysterectomy as determined by magnetic resonance imaging. The medical records of 155 patients who underwent a hysterectomy between January 2007 and April 2010 were examined. We also compared the indications and outcomes of LAVH and TLH for myomas larger than 7 cm. Patients who underwent LAVH or TLH had a lower average intraoperative blood loss, less intense postoperative pain, and shorter hospital stays than patients in the TAH group, although the length of the operations in the laparoscopic groups were significantly longer. To evaluate the selection criteria for the large sized myomas, we compared the LAVH and TLH groups for the myomas larger than 7 cm. The greatest uterine transverse diameters and the weight of the uteri were not significantly different between the LAVH and TLH groups (94.7 ± 20.8 and 83.1 ± 17.6 mm, 371.6 ± 160.3 and 286.7 ± 158.0 g, respectively). The average intraoperative blood loss in the TLH group was significantly lower than that in the LAVH (121.3 ± 111.2 vs 379.3 ± 222.4 g, P < 0.001). Our data suggest that TLH is a better procedure for treating a large uterus no larger than 10 cm in its greatest transverse diameter. The preoperative total length of myoma nodules determined by MRI is a useful preoperative indicator of the uterine weight.

Comparison of prevalence of hypoactive sexual desire disorder (HSDD) in women after five different hysterectomy procedures

The advantages of the various methods used for hysterectomy are currently a topic of debate, and there is particular controversy over whether the cervix should be left in situ or not. The aim of this study was to compare the prevalence of hypoactive sexual desire disorder (HSDD) after five different hysterectomy procedures. The Brief Profile of Female Sexual Function (B-PFSF) score was measured to compare postoperative prevalence of HSDD after the different surgical procedures. The questionnaire was sent to 590 women who had undergone hysterectomy between 2002 and 2007 for benign conditions. The following procedures were performed: abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopy-assisted vaginal hysterectomy (LAVH), laparoscopic supracervical hysterectomy (LASH), and total laparoscopic hysterectomy (TLH). A total of 304 questionnaires returned and 258 were found to be eligible for analysis. The mean follow-up intervals were 2 years for women after LASH and TLH and 3 years for women after AH, VH, and LAVH. The women in the AH group were significantly older than those in the LASH group, and the women in the VH group were significantly older than those in the LASH or TLH groups. The median B-PFSF score was highest at 26 in women after LASH, 25 in women after TLH, 23 in women after LAVH, 23.5 in women after VH, and 21 in women after AH. There were no statistically significant differences between the groups. No differences were observed using the B-PFSF score with regard to the prevalence of HSDD after hysterectomy, irrespective of the surgical technique used.

Effects of Electrosurgery and Vaginal Closure Technique on Postoperative Vaginal Cuff Dehiscence

The aim of our study is to evaluate the role of electrosurgery and vaginal closure technique in the development of postoperative vaginal cuff dehiscence. From prospective surgical databases, we identified 463 patients who underwent total laparoscopic hysterectomy (TLH) for benign disease and 147 patients who underwent laparoscopic-assisted vaginal hysterectomy (LAVH) for cancer. All TLHs and LAVHs were performed entirely by use of electrosurgery, including colpotomy. Colpotomy in the TLH group was performed with Harmonic Ace Curved Shears (Ethicon Endo-Surgery, Cincinnati, OH, USA), and in the LAVH group, it was performed with a monopolar electrosurgical pencil. The main surgical difference was vaginal cuff closure--laparoscopically in the TLH group and vaginally in the LAVH group. Although patients in the LAVH group were at increased risk for poor healing (significantly older, higher body mass index, more medical comorbidities, higher blood loss, and longer operative time), there were no vaginal cuff dehiscences in the LAVH group compared with 17 vaginal cuff dehiscences (4%) in the TLH group (P = .02). It does not appear that the increased vaginal cuff dehiscence rate associated with TLH is due to electrosurgery; rather, it is due to the vaginal closure technique.

Evaluation of total laparoscopic hysterectomy with lymphadenectomy in surgical treatment of endometrial cancers

The study was conducted to evaluate the efficacy feasibility and safety of total laparoscopic hysterectomy (TLH) with lymphadenectomy in the treatment of endometrial cancer The retrospective study included 31 patients with endometrial cancer who underwent TLH with lymphadenectomy and 42 patients with endometrial cancer who were operated by laparotomy. In both groups the following parameters were analyzed: age, BMI, accompanying diseases, previous surgeries, parity duration of the surgery blood loss (complete blood count before and after the operation was compared), necessity of blood transfusion, length of hospital stay uterine volume, grade, stage of endometrial cancer (FIGO), and intra/ postoperative complications. Mean age of patients was lower in the laparoscopic group than in women operated by laparotomy: 54 and 64, respectively (p = 0.0001). There were no significant differences between both groups in BMI, uterine volume, grade, staging (FIGO), and parity The percentage of patients with accompanying chronic diseases in the TLH group was lower than in the laparotomy group: 48.39% and 83.34%, respectively (p = 0,032). There were no significant differences between both group in the history of previous laparotomies (p = 0.704). Mean duration of surgery was shorter in the case of laparotomy than in case of laparoscopy: 130.6 and 151.77, respectively (p = 0.003). Laparotomy was associated with greater blood loss during surgery Statistically significantly higher decrease in the Hb concentration and Hct values was noted in the group operated by laparotomy when compared to laparoscopy (mean values.: Hb-1.1 7 g/dl, Hct-3.49% for the TLH technique and Hb-7.8 g/dl Hct-5.47% for laparotomy; p = 0.011-Hb; p = 0.003-Hct). Mean hospital stay after laparoscopy was shorter than after laparotomy--4 and 9 days, respectively (p = 0,0001). The influence of the operational technique on the number of pelvic lymph nodes taken for histopathological examination was evaluated. No statistically significant correlation between the number of lymph nodes taken for histopathological examination during the surgery and the operational technique was noted (p = 0.083). Mean number of nodes taken for examination was 15 during the TLH surgery and 19 during laparotomy Postoperative complications were observed in 2 patients from the TLH and in 12 patients from the laparotomy groups (p = 0.038). The most statistically significantly frequent complication in the laparotomy group was postoperative wound infection: 8 (19.05%) patients. Total laparoscopic hysterectomy with lymphadenectomy in endometrial cancer therapy is a safe and feasible procedure. It is characterized by significantly smaller percentage of complications and shorter hospital stay This technique offers an alternative for laparotomy when it is performed by a highly experienced surgeon.

Differences in Epidural and Analgesic Use in Patients with Apparent Stage I Endometrial Cancer Treated by Open versus Laparoscopic Surgery: Results from the Randomised LACE Trial

Objectives. We compared postoperative analgesic requirements between women with early stage endometrial cancer treated by total abdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH). Methods. 760 patients with apparent stage I endometrial cancer were treated in the international, multicentre, prospective randomised trial (LACE) by TAH (n = 353) or TLH (n = 407) (2005–2010). Epidural, opioid, and nonopioid analgesic requirements were collected until ten months after surgery. Results. Baseline demographics and analgesic use were comparable between treatment arms. TAH patients were more likely to receive epidural analgesia than TLH patients (33% versus 0.5%, P < 0.001) during the early postoperative phase. Although opioid use was comparable in the TAH versus TLH groups during postoperative 0–2 days (99.7% versus 98.5%, P = 0.09), a significantly higher proportion of TAH patients required opioids 3–5 days (70% versus 22%, P < 0.0001), 6–14 days (35% versus 15%, P < 0.0001), and 15–60 days (15% versus 9%, P = 0.02) after surgery. Mean pain scores were significantly higher in the TAH versus TLH group one (2.48 versus 1.62, P < 0.0001) and four weeks (0.89 versus 0.63, P = 0.01) following surgery. Conclusion. Treatment of early stage endometrial cancer with TLH is associated with less frequent use of epidural, lower post-operative opioid requirements, and better pain scores than TAH.

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 between Robot-Assisted Laparoscopic Hysterectomy and Total Laparoscopic Hysterectomy: A Cohort Study

Objective. To compare the operative outcomes in patients who underwent robot-assisted total laparoscopic hysterectomy (RLH) versus total laparoscopic hysterectomy (TLH). Study Design. Retrospective chart review. All women who underwent RLH in hospital A and TLH in hospital B by a single surgeon were included. Results. 136 patients were included (73 in the RLH group and 63 in the TLH group). There were no conversions to laparotomy in the RLH group versus 7 (11.1%) in the TLH group (). The mean induction time was significantly greater (by 6 minutes) for RLH, independent of docking time, as compared to TLH (). Total procedure time was significantly less in the RLH group (82 minutes) as compared to TLH (108 minutes) (). Mean blood loss was less for RLH (46 mL) as compared to TLH (114 mL) (). A greater number of patients who underwent RLH were discharged on postoperative day 0 as compared to those receiving TLH (). Conclusion. RLH is a safe alternative to TLH and may offer some operative advantages, including fewer conversions to laparotomy, reduced procedure time, less blood loss, and earlier discharge.

Improved surgical safety after laparoscopic compared to open surgery for apparent early stage endometrial cancer: Results from a randomised controlled trial

AimTo compare Total Laparoscopic Hysterectomy (TLH) and Total Abdominal Hysterectomy (TAH) with regard to surgical safety. MethodsBetween October 2005 and June 2010, 760 patients with apparent early stage endometrial cancer were enroled in a multicentre, randomised clinical trial (LACE) comparing outcomes following TLH or TAH. The main study end points for this analysis were surgical adverse events (AE), hospital length of stay, conversion from laparoscopy to laparotomy, including 753 patients who completed at least 6weeks of follow-up. Postoperative AEs were graded according to Common Toxicity Criteria (V3), and those immediately life-threatening, requiring inpatient hospitalisation or prolonged hospitalisation, or resulting in persistent or significant disability/incapacity were regarded as serious AEs. ResultsThe incidence of intra-operative AEs was comparable in either group. The incidence of post-operative AE CTC grade 3+ (18.6% in TAH, 12.9% in TLH, p 0.03) and serious AE (14.3% in TAH, 8.2% in TLH, p 0.007) was significantly higher in the TAH group compared to the TLH group. Mean operating time was 132 and 107min, and median length of hospital stay was 2 and 5days in the TLH and TAH group, respectively (p<0.0001). The decline of haemoglobin from baseline to day 1 postoperatively was 2g/L less in the TLH group (p 0.006). ConclusionsCompared to TAH, TLH is associated with a significantly decreased risk of major surgical AEs. A laparoscopic surgical approach to early stage endometrial cancer is safe.

Robotic Assisted, Total Laparoscopic, and Total Abdominal Hysterectomy for Management of Uterine Cancer

The purpose was to compare robotic assisted total laparoscopic hysterectomy (TRH), laparoscopic assisted hysterectomy (TLH) and total abdominal hysterectomy (TAH) with surgical staging +/- lymphadenectomy for the management of uterine cancer. Institutional review board approval was obtained and patient characteristics, pathologic data, and data related to the surgical procedure were collected from chart review. Data were analyzed with SAS statistical software. A total of 102 TRHs were compared to 115 TLHs and 79 TAHs. There were more grade I and endometrial intraepithelial (EIN) lesions in the preoperative pathology of TLHs (P < 0.01). Pelvic lymphadenectomy was performed in 71 (70%) TRH, 46 (58%) TAH, and 28 (24%) TLH cases (P < 0.01). Mean surgical time was 203, 133 and 132 minutes for TRHs, TLHs, and TAHs (P < 0.05). Estimated blood loss was 69, 86, and 215 ml for TRH, TLH, and TAH (P < 0.05). Blood transfusions were 19% in TAHs versus 3% and 2% in TLHs and TRHs (P < 0.01). There were fewer wound infections (2% vs. 10%) in TRHs versus TAHs (P < 0.01). Length of stay was shorter for the TRH and TLH groups (P < 0.05). Despite longer surgical times, benefits of minimally invasive technology included shortened length of stay, decreased wound infections, transfusions, and blood loss. In our population, procedure selection for TLH versus TRH may have been influenced by lower preoperative grade, with reservation of robotic technology for cases anticipated to be more complex, and therefore justifying increased technology costs and operating times.