Total Laparoscopic Hysterectomy Group Research Articles

Total laparoscopic hysterectomy versus da Vinci robotic hysterectomy: is using the robot beneficial?

ObjectiveTo compare the outcomes of total laparoscopic to robotic approach for hysterectomy and all indicated procedures after controlling for surgeon and other confounding factors.MethodsRetrospective chart review of all consecutive cases of total laparoscopic and da Vinci robotic hysterectomies between August 2007 and July 2009 by two gynecologic oncology surgeons. Our primary outcome measure was operative procedure time. Secondary measures included complications, conversion to laparotomy, estimated blood loss and length of hospital stay. A mixed model with a random intercept was applied to control for surgeon and other confounders. Wilcoxon rank-sum, chi-square and Fisher's exact tests were used for the statistical analysis.ResultsThe 124 patients included in the study consisted of 77 total laparoscopic hysterectomies and 47 robotic hysterectomies. Both groups had similar baseline characteristics, indications for surgery and additional procedures performed. The difference between the mean operative procedure time for the total laparoscopic hysterectomy group (111.4 minutes) and the robotic hysterectomy group (150.8 minutes) was statistically significant (p=0.0001) despite the fact that the specimens obtained in the total laparoscopic hysterectomy group were significantly larger (125 g vs. 94 g, p=0.002). The robotic hysterectomy group had statistically less estimated blood loss than the total laparoscopic hysterectomy group (131.5 mL vs. 207.7 mL, p=0.0105) however no patients required a blood transfusion in either group. Both groups had a comparable rate of conversion to laparotomy, intraoperative complications, and length of hospital stay.ConclusionTotal laparoscopic hysterectomy can be performed safely and in less operative time compared to robotic hysterectomy when performed by trained surgeons.

Total Laparoscopic Hysterectomy and Laparoscopy-Assisted Vaginal Hysterectomy

To compare the feasibility of total laparoscopic hysterectomy (TLH) and laparoscopy-assisted vaginal hysterectomy (LAVH) in the treatment of benign gynecologic diseases and to determine the selection criteria for each technique. This was a retrospective medical records review of 168 patients who underwent TLH or LAVH performed by one surgeon. A chi-square test was used to compare the difference between the TLH and LAVH groups. Pearson's correlation coefficient was calculated for the relationship between the clinico-demographic factors of the patients. There were no differences between the 2 groups with respect to age, parity, history of abdominal delivery, body mass index, and indication for hysterectomy. The operative time was similar between the 2 groups (P>.99). The uterine weight was greater in the LAVH group compared to the TLH group (P<.01). Ten patients were converted from TLH to LAVH, because of a large uterus and/or a lower segmental mass on the uterus, making it difficult to expose the Koh cup rim contour. TLH and LAVH are safe, feasible methods by which to perform a hysterectomy. LAVH is preferred in patients with a mass involving the lower segment or a relatively large uterus.

Comparison of two different laparoscopic hysterectomies: laparoscopic hysterectomy vs. total laparoscopic hysterectomy

The aim of this study was to compare the efficacy and safety of laparoscopic hysterectomy (LH) and Total Laparoscopic Hysterectomy (TLH). Both types of hysterectomy were performed by retroperitoneal uterine artery sealing using LigaSure™ by four-puncture. A total of 45 patients were operated on by LH and 22 by TLH. The mean operation time, amount of intraoperative bleeding, drop in hemoglobin concentration, weight of removed uterus, major and minor per-post operative complications, and rate of conversion to the classical abdominal approach in the two groups were compared. The mean operation time in TLH (110 min.) was significantly longer than in LH (65 min.). This was mainly due to the shorter mean operating time in the vaginal part of LH group (13 min.) compared to laparoscopic dissection of uterosacral ligaments and vaginal suturing (42 min.) in the TLH group. Median blood loss was also significantly higher in the TLH group (278 ml.) compared to the LH group (110 ml.). There were no significant differences in the mean drop of hemoglobin concentration, uterine weight, major and minor complications and conversion to laparotomy between the groups. LH seems to be a faster and more demanding method than TLH. With its shorter operation time and less bleeding, LH may be preferred to TLH.

Comparison of the Clinical Characteristics between Total Laparoscopic Hysterectomy (TLH) and Laparoscopy-Assisted Vaginal Hysterectomy (LAVH)

Study Objective: To help selecting better surgical procedure by comparing clinical characteristics between total laparoscopic hysterectomy (TLH) and laparoscopy-assisted vaginal hysterectomy (LAVH). Design: Retrospective study. Setting: From July to December, 2006, total 165 cases of patients were performed hysterectomy (TLH 66cases, LAVH 99cases) at Gachon university of medicine and science Gil Medical Center. Patients: The indications of hysterectomy were uterine myoma, adenomyosis, carcinoma in situ, endometrial hyperplasia, ovarian tumor, and dysfunctional uterine bleeding. Intervention: All patients received hysterectomy including TLH and LAVH. We analyzed these cases about age, body mass index, parity, previous operation history, operation indication, operation outcome and complication. Measurements and Main Results: There were no significant differences in terms of patient's age, parity and previous operation history between the two groups. The body mass index was significantly higher in TLH group(p=0.017). The main indications were myoma and adenomyosis. There were no significant differences in uterine weight, blood loss and hemoglobin change between the two groups. The mean operation time was significantly longer in TLH group(p=0.001) and the length of hospital stay was shorter in TLH group(p=0.007). There were 14 cases(8.5%) of complications in total 165 cases. The major complications such as urinary tract injury and urinary fistula were 2 cases for TLH and 3cases for LAVH. Conclusion: LAVH has the merit of short operation time, compared with TLH, but has no significant differences in other clinical variables.

Case Series Analysis: Biclamp® Total Laparoscopic Hysterectomy Versus Biclamp® Vaginal Hysterectomy – Is There a Clear Winner?

Study Objective: To compare burgeoning techniques of hysterectomy, compare efficacy of and safety of Total Laparoscopic Hysterectomy (TLH) versus Vaginal Hysterectomy (VH) both approaches utilising ERBE Biclamp® technology. Design: A retrospective case series comparing operative profiles of 35 consecutive Biclamp® Total Laparoscopic Hysterectomies with 35 consecutive Biclamp® Vaginal Hysterectomies performed between 1/11/07 to 03/4/09. Setting: Antrim Area Hospital, Department of Gynaecology, Northern Ireland. Patients: 70 patients with varying indications for hysterectomy. Measurements and Main Results: Operative time, blood loss, complications and hospital stay were the primary outcomes of study. Mean operating time for the TLH group was 73 minutes (range 45-175 min) versus 83 minutes (range 50-120 min) for the VH series. Estimated blood loss was approximately 4 times less in the TLH group, average 56 ml versus 200ml in the VH series. Mean uterine size was 169 grams (range 62-575 grams) in the TLH group versus 118 grams in the vaginal hysterectomy series (range 48- 602 grams). A much shorter hospital stay was noted in the TLH series with an average of 34 hours, which approached 24 hours towards the end of the series. This compared to an average of 84 hours in the VH series. No major intra-operative complications were observed in either group. In the TLH series one patient developed a port site hernia and one experienced transient urinary retention. In the VH series 2 patients required blood transfusions and 2 urinary tract infections occurred. Conclusion: Considerably shorter hospital stay, operative time, blood loss and morbidity where noted in the total laparoscopic hysterectomy series compared with the vaginal hysterectomy series.

Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE): a randomised trial

This two-stage randomised controlled trial, comparing total laparoscopic hysterectomy (TLH) with total abdominal hysterectomy (TAH) for stage I endometrial cancer (LACE), began in 2005. The primary objective of stage 1 was to assess whether TLH results in equivalent or improved quality of life (QoL) up to 6 months after surgery compared with TAH. The primary objective of stage 2 was to test the hypothesis that disease-free survival at 4.5 years is equivalent for TLH and TAH. Here, we present the results of stage 1. Between Oct 7, 2005, and April 16, 2008, 361 participants were enrolled in the QoL substudy at 19 centres across Australia, New Zealand, and Hong Kong; 332 completed the QoL analysis. Randomisation was done centrally and independently from other study procedures via a computer-generated, web-based system (providing concealment of the next assigned treatment), using stratified permuted blocks of three and six patients. Patients with histologically confirmed stage I endometrioid adenocarcinoma and Eastern Cooperative Oncology Group performance status less than 2 were randomly assigned to TLH (n=190) or TAH (n=142), stratified by histological grade and study centre. Patients and study personnel were not masked to treatment assignment. QoL was measured at baseline, 1 and 4 weeks (early), and 3 and 6 months (late) after surgery, using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire. The primary endpoint was the difference between groups in QoL change from baseline at early and late timepoints (a 5% difference was considered clinically significant). Analysis was done according to the intention-to-treat principle. Patients for both stages of the trial have now been recruited and are being followed up for disease-specific outcomes. The LACE trial is registered with ClinicalTrials.gov, number NCT00096408. Eight of 332 patients (2.4%) had treatment conversion-seven from TLH to TAH and one from TAH to TLH (patient preference). In the early phase of recovery, patients who had TLH reported significantly greater improvement in QoL from baseline compared with those who had TAH, in all subscales apart from emotional and social wellbeing. Improvements in QoL up to 6 months after surgery continued to favour TLH, except in the emotional and social wellbeing measures of FACT and the visual analogue scale of the EuroQoL five dimensions (EuroQoL-VAS). Operating time was significantly longer in the TLH group (138 min [SD 43]) than in the TAH group (109 min [34]; p=0.001). Although the proportion of intraoperative adverse events was similar between groups (TAH eight of 142 [5.6%] vs TLH 14 of 190 [7.4%]; p=0.53); postoperatively, twice as many patients in the TAH group experienced adverse events of grade 3 or higher (33 of 142 [23.2%] vs 22 of 190 [11.6%] in the TLH group; p=0.004). Postoperative serious adverse events occurred more in the TAH group (27 of 142 [19.0%]) than in the TLH group (16 of 190 [7.9%]; p=0.002). QoL improvements from baseline during early and later phases of recovery, and the adverse event profile, favour TLH compared with TAH for treatment of stage I endometrial cancer. Cancer Council Queensland, Cancer Council New South Wales, Cancer Council Victoria, Cancer Council Western Australia; NHMRC project grant 456110; Cancer Australia project grant 631523; The Women and Infants Research Foundation, Western Australia; Royal Brisbane and Women's Hospital Foundation; Wesley Research Institute; Gallipoli Research Foundation; Gynetech; TYCO Healthcare, Australia; Johnson and Johnson Medical, Australia; Hunter New England Centre for Gynaecological Cancer; Genesis Oncology Trust; and Smart Health Research Grant QLD Health.

Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomised trial

The standard surgery for early-stage endometrial cancer is total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy, which is associated with substantial morbidity. Total laparoscopic hysterectomy (TLH) and bilateral salpingo-oophorectomy is less invasive and is assumed to be associated with lower morbidity, particularly in obese women. This study investigated the complication rate of TLH versus TAH in women with early-stage endometrial cancer. This randomised trial was done in 21 hospitals in The Netherlands, and 26 gynaecologists with proven sufficient skills in TLH participated. 283 patients with stage I endometrioid adenocarcinoma or complex atypical hyperplasia were randomly allocated (2:1) to the intervention group (TLH, n=187) or control group (TAH, n=96). Randomisation by sequential number generation was done centrally in alternate blocks of six and three participants, with stratification by trial centre. After assignment, the study coordinators, patients, gynaecologists, and members of the panel were not masked to intervention. The primary outcome was major complication rate, assessed by an independent panel. Data were analysed by a modified intention-to-treat analysis, since two patients in both groups were excluded from the main analysis. This trial is registered with the Dutch trial registry, number NTR821. The proportion of major complications was 14.6% (27 of 185) in the TLH group versus 14.9% (14 of 94) in the TAH group, with a difference of -0.3% (95% CI -9.1 to 8.5; p=0.95). The proportion of patients with an intraoperative major complication (nine of 279 [3.2%]) was lower than the proportion with a postoperative major complication (32 of 279 [11.5%]) and did not differ between TLH (five of 185 [2.7%]) and TAH (four of 94 [4.3%]; p=0.49). The proportion of patients with a minor complication was 13.0% (24 of 185) in the TLH group and 11.7% (11 of 94) in the TAH group (p=0.76). Conversion to laparotomy occurred in 10.8% (20 of 185) of the laparoscopic procedures. TLH was associated with significantly less blood loss (p<0.0001), less use of pain medication (p<0.0001), a shorter hospital stay (p<0.0001), and a faster recovery (p=0.002), but the procedure took longer than TAH (p<0.0001). Our results showed no evidence of a benefit for TLH over TAH in terms of major complications, but TLH (done by skilled surgeons) was beneficial in terms of a shorter hospital stay, less pain, and quicker resumption of daily activities. The Dutch Organization for Health Research and Development (ZonMw), programme efficacy.

Comparison of clinical effects between total vaginal hysterectomy and total laparoscopic hysterectomy on large uteruses over 300 grams

To compare intra- and postoperative complications, operation time, and duration of hospital stay, and to evaluate cost-effectiveness between total vaginal hysterectomy (TVH) and total laparoscopic hysterectomy (TLH) groups. Patients undergoing TVH or TLH for a large uterus weighing more than 300 g were recruited from January to December 2007: 150 cases of TVH and 100 cases of TLH, were used. Evaluated variables are as follows: age, parity, previous surgical history, intra- and postoperative complications, hysterectomy specimen weight, operation time, duration of hospital stay and total cost. Total cost ($US) include admission, anesthesia and operation costs. There was no difference in demographics, intra- and postoperative complications, and uterine weight. However, operation time in TLH (mean, 179.9 min) was significantly longer than TVH (mean, 93.8 min; P < 0.05). The mean length of hospital stay was 6.13 days in TVH group and 5.78 days in TLH group, respectively (P < 0.05). TVH was more cost-effective than TLH. There was significant difference in total cost between the two groups (TVH, mean $1815.7 vs TLH, mean $2560.5; P < 0.05). When the total cost was analyzed in detail, there was no difference in admission cost. However, the significant mean differences in anesthesia cost (TVH, $165 vs TLH, $245) and operation cost (TVH, $30.3 vs TLH, $768) were demonstrated (P < 0.05). TVH should not be abandoned for cases with a large uterus, and skilled surgeons for vaginal approach should preferentially perform TVH rather than TLH for the management of large uteruses.

Transumbilical single-port access versus conventional total laparoscopic hysterectomy: surgical outcomes

The objective of the study was to compare surgical outcomes and postoperative pain between transumbilical single-port access total laparoscopic hysterectomy (SPA-TLH) and conventional 4-port total laparoscopic hysterectomy (TLH). We retrospectively reviewed 157 patients who underwent SPA-TLH (n = 52) or conventional TLH (n = 105). A single-port access system consisted of a wound retractor, surgical glove, 2 5 mm trocars, and 1 10/11 mm trocar. The SPA-TLH group had less intraoperative blood loss (P < .001), shorter hospital stay (P = .001), and earlier diet intake (P < .001) compared with the conventional TLH group. There was no difference in perioperative complications. Immediate postoperative pain score was lower in the SPA-TLH group (P < .001). Postoperative pain after 6 and 24 hours was lower in SPA-TLH with marginal statistical significance. SPA-TLH is a feasible method for hysterectomy with lower immediate postoperative pain and better surgical outcomes with respect to recovery time compared with conventional TLH.

A series of 400 laparoscopic hysterectomies for benign disease: a single centre, single surgeon prospective study of complications confirming previous retrospective study

The aim of this study was to evaluate the complication rate after total and subtotal laparoscopic hysterectomy for benign disease performed by the same surgeon after an adequate learning curve. We conducted a prospective evaluation of complications in a continuous series of 400 women undergoing laparoscopic subtotal hysterectomy (LASH) or total laparoscopic hysterectomy (TLH) between October 2005 and January 2009. In the LASH group (n = 148), both the minor and major complication rates were 1.35% (n = 2; n = 2), whereas in the TLH group (n = 252), the rate was 1.59% for major complications (n = 4) and 0% for minor complications, clearly confirming that laparoscopic hysterectomy is safe in experienced hands, especially in terms of urinary tract injuries.

Clinical study on different operation procedure for laparoscopic hysterectomy

目的 探讨4种不同途径腹腔镜下子宫切除术的临床应用.方法 回顾性分析208例腹腔镜子宫切除术患者的临床资料,其中腹腔镜辅助阴式子宫切除术(LAVH)83例、腹腔镜下全子宫切除术(TLH)64例、腹腔镜下筋膜内子宫切除术(CISH)35例、腹腔镜下子宫次全切除术(LSH)26例,比较各组患者术中及术后的情况.结果 平均手术时间LAVH组(115.60±22.81)min,TLH组(135.36±28.11)min,CISH组(103.69±19.18)min,LSH组(84.23±18.42)min,术中出血量LAVH组(130.44±27.35)组ml,TLH组(143.55±29.86)ml,CISH组(103.84±31.72)ml,LSH组(80.29±21.41)ml,LSH组与其它组比较,差异均有统计学意义(P<0.05).结论 不同途径腹腔镜子宫切除术各有优势,且互不能完全替代,应根据患者的情况、手术医生的技术水准、医院的条件等综合考虑。

Total Laparoscopic Hysterectomy and Laparoscopy-Assisted Vaginal Hysterectomy

Study Objective: To investigate the feasibility of and the factors affecting the choice between total laparoscopic hysterectomy(TLH) and laparoscopy-assisted vaginal hysterectomy(LAVH) for the treatment of benign uterine disease.Design: Retrospective analysis of 168 patients who underwent either TLH or LAVH by a single surgeon.Setting: University Hospital.Patients: One hundred sixty eight women with benign uterine disease.Intervention: Total laparoscopic hysterectomy and laparoscopy-assisted vaginal hysterectomy.Measurements and Main Results: There were no differences between the two groups with respect to the age, parity, history of abdominal delivery, body mass index, indication for hysterectomy, and complication rates. The operative time was similar between the two groups (p > .99). The hemoglobin change was greater in the LAVH group compared to TLH group (P = .02). The uterine weight was heavier in LAVH group compared to TLH group (p < .01). Ten patients were converted from a TLH to a LAVH due to a large uterine size or lower segment mass of the uterus. The mean uterine weight was 252.60 ± 100.19 g in the conversion group (TLH→LAVH) and was heavier than the TLH group (189.70 ± 108.98 g), but there was no significant difference (P = .087). One ureteral and one bladder injury occurred in the TLH and LAVH group, respectively. No major vascular or bowel injuries occurred.Conclusion: TLH and LAVH are safe and feasible methods of a hysterectomy. LAVH may be preferred in cases involving a large uterus or lower segment mass of the uterus. Study Objective: To investigate the feasibility of and the factors affecting the choice between total laparoscopic hysterectomy(TLH) and laparoscopy-assisted vaginal hysterectomy(LAVH) for the treatment of benign uterine disease. Design: Retrospective analysis of 168 patients who underwent either TLH or LAVH by a single surgeon. Setting: University Hospital. Patients: One hundred sixty eight women with benign uterine disease. Intervention: Total laparoscopic hysterectomy and laparoscopy-assisted vaginal hysterectomy. Measurements and Main Results: There were no differences between the two groups with respect to the age, parity, history of abdominal delivery, body mass index, indication for hysterectomy, and complication rates. The operative time was similar between the two groups (p > .99). The hemoglobin change was greater in the LAVH group compared to TLH group (P = .02). The uterine weight was heavier in LAVH group compared to TLH group (p < .01). Ten patients were converted from a TLH to a LAVH due to a large uterine size or lower segment mass of the uterus. The mean uterine weight was 252.60 ± 100.19 g in the conversion group (TLH→LAVH) and was heavier than the TLH group (189.70 ± 108.98 g), but there was no significant difference (P = .087). One ureteral and one bladder injury occurred in the TLH and LAVH group, respectively. No major vascular or bowel injuries occurred. Conclusion: TLH and LAVH are safe and feasible methods of a hysterectomy. LAVH may be preferred in cases involving a large uterus or lower segment mass of the uterus.

Laparoscopic Uterosacral Ligament Suspension for the Prevention of Uterovaginal Prolapse Associated with Burch Colposuspension

Study Objective: To assess the surgical outcomes and postoperative quality of life of concurrent laparoscopic uterosacral ligament suspension (LUSLS) and Laparoscopic Burch Colposuspension (LBC) and evaluate if the addition of LUSLS to LBC could prevent recurrent uterovaginal prolapse.Design: Retrospective chart review of 70 patients who had LBC with prophylactic LUSLS by a single surgeon.Setting: Urban gynaecologic laparoscopy practice of single gynaecologist.Patients: Seventy (70) women undergoing laparoscopic Burch Colposuspension with uterosacral ligament suspension concurrently.11 patients (16%) had previously had a hysterectomy. These patients were then subdivided into an anterior group who had only anterior compartment surgery with BC and LUSLS with (16) and without (16) Total Laparoscopic Hysterectomy (TLH), and a posterior group containing patients who had additional posterior compartment surgery with (14) and without (24) TLH.Intervention: Laparoscopic Burch colposuspension and uterosacral ligament suspension procedures.Measurements and Main Results: Preoperative and postoperative (6wk, 12 month, 24 month and 36 month) POP- Q evaluations were performed by a single examiner and recorded. Pelvic Floor Distress Inventory-SF20 (PFD) was administered postoperatively. Six patients had subsequent surgery representing a reoperation rate of 8.5%. Significant complications occurred in 6 (8.5%) patients with 5 retropubic haematomas and 1 cystotomy associated with TLH. There were 2 (2.8%) reoperations in the anterior group; 0 with no TLH, 2 reoperations with TLH There were 4 (5.7%) reoperations in the posterior group with 2 in the no TLH group and 2 in the TLH group. Mean PFDI scores were low at 8.9 in the posterior group and 7.9 in the anterior group. There was no recurrence of stress incontinence in either group.Conclusion: Prophylactic LUSLS performed with LBC together with site specific repair at the primary surgery offers a very low reoperation rate and good postoperative quality of life. It does not appear to interfere with the proven success rate of LBC and is easy to perform. Study Objective: To assess the surgical outcomes and postoperative quality of life of concurrent laparoscopic uterosacral ligament suspension (LUSLS) and Laparoscopic Burch Colposuspension (LBC) and evaluate if the addition of LUSLS to LBC could prevent recurrent uterovaginal prolapse. Design: Retrospective chart review of 70 patients who had LBC with prophylactic LUSLS by a single surgeon. Setting: Urban gynaecologic laparoscopy practice of single gynaecologist. Patients: Seventy (70) women undergoing laparoscopic Burch Colposuspension with uterosacral ligament suspension concurrently.11 patients (16%) had previously had a hysterectomy. These patients were then subdivided into an anterior group who had only anterior compartment surgery with BC and LUSLS with (16) and without (16) Total Laparoscopic Hysterectomy (TLH), and a posterior group containing patients who had additional posterior compartment surgery with (14) and without (24) TLH. Intervention: Laparoscopic Burch colposuspension and uterosacral ligament suspension procedures. Measurements and Main Results: Preoperative and postoperative (6wk, 12 month, 24 month and 36 month) POP- Q evaluations were performed by a single examiner and recorded. Pelvic Floor Distress Inventory-SF20 (PFD) was administered postoperatively. Six patients had subsequent surgery representing a reoperation rate of 8.5%. Significant complications occurred in 6 (8.5%) patients with 5 retropubic haematomas and 1 cystotomy associated with TLH. There were 2 (2.8%) reoperations in the anterior group; 0 with no TLH, 2 reoperations with TLH There were 4 (5.7%) reoperations in the posterior group with 2 in the no TLH group and 2 in the TLH group. Mean PFDI scores were low at 8.9 in the posterior group and 7.9 in the anterior group. There was no recurrence of stress incontinence in either group. Conclusion: Prophylactic LUSLS performed with LBC together with site specific repair at the primary surgery offers a very low reoperation rate and good postoperative quality of life. It does not appear to interfere with the proven success rate of LBC and is easy to perform.

Twenty-first century laparoscopic hysterectomy: should we not leave the vaginal step out?

The objective of this study was to compare surgical outcomes for laparoscopically assisted vaginal hysterectomy (LAVH) with total laparoscopic hysterectomy (TLH) in three teaching hospitals in the Netherlands. This study is a multicenter cohort retrospective analysis of consecutive cases (Canadian Task Force classification II-2). One hundred and four women underwent a laparoscopic hysterectomy between March 1995 and March 2005 at one of three teaching hospitals. This included 37 women who underwent LAVH and 67 who underwent TLH. Blood loss, operating time, and intraoperative complications such as bladder or ureteric injury as well as conversion to an open procedure were recorded. In the TLH group, average age was statistically significant lower, as well as the mean parity, whereas estimated uterus size was statistically significant larger, compared to the LAVH group. Main indication in both groups was dysfunctional uterine bleeding. In the TLH group, mean blood loss (173 mL) was significant lower compared to the LAVH group (457 mL), whereas length of surgery, uterus weight, and complication rates were comparable between the two groups. The method of choice at the start of the study period was LAVH, and by the end of the study period, it had been superceded by TLH. LAVH should not be regarded as the novice’s laparoscopic hysterectomy. Moreover, with regard blood loss, TLH shows advantages above LAVH. This might be due to the influence of the altered anatomy in the vaginal stage of the LAVH procedure. Therefore, when a vaginal hysterectomy is contraindicated, TLH is the procedure of choice. LAVH remains indicated in case of vaginal hysterectomy with accompanying adnexal surgery.

Comparison of total laparoscopic hysterectomy (TLH) and laparoscopy-assisted supracervical hysterectomy (LASH) in women with uterine leiomyoma

Objective To compare total laparoscopic hysterectomy (TLH) using the Hohl instrument with laparoscopy-assisted supracervical hysterectomy (LASH) in women with uterine leiomyoma. Study design 231 women underwent laparoscopic hysterectomy for the treatment of symptomatic leiomyoma between January 2005 and December 2007. A total of 113 women decided to undergo complete hysterectomy with removal of the cervix (TLH group) and 118 women wished to preserve the cervix; LASH was carried out in the latter group (LASH group). Results No ureteral or bladder injury occurred in any of the patients. Two intraoperative complications and one postoperative complication occurred in the TLH group, while no complications occurred in the LASH group. When the TLH group was compared with the LASH group, the mean loss of hemoglobin was 1.6 ± 1.1 g/dL (95% CI 1.4–1.8) vs. 1.5 ± 1.4 g/dL (95% CI 1.2–1.7); the mean operating time was 114.0 ± 33.8 min (95% CI 107.6–120.2) vs. 116.5 ± 40 min (95% CI 109.3–124.0); and the mean uterus weight was 264.8 ± 133.6 g (95% CI 239.8–289.6) vs. 286.2 ± 209.3 g (95% CI 247.4–324.4). Hospital stay and use of analgesia in both groups were equal. No statistically significant differences were found. Conclusions TLH using the Hohl instrument is an option comparable with laparoscopy-assisted supracervical hysterectomy for women with uterine leiomyoma. However, the complication rates may be lower when LASH is performed.

Do new vessel sealing devices and harmonic ace increase ureteric injury in total laparoscopic hysterectomy?

Objectives:To compare the risk of ureteric injury in total laparoscopic hysterectomy (TLH) using new vessel sealing devices (VSDs) and harmonic scalpel with simple scissors, bipolar and suturing. This was an evaluation of 1209 cases, carried out from May 1999 to April 2010.Design and Setting:A retrospective comparative study was carried out at a tertiary gynecological endoscopic unit.Materials and Methods:Out of 1209 patients, who had hysterectomies for various indications, TLH was done in 892 patients, 273 had vaginal hysterectomy and 44 had abdominal hysterectomy. We evaluated the incidence of ureteric injury in these cases.Results:There was no mortality. In the group of vaginal and abdominal hysterectomy, there were no ureteric injuries. In the TLH group, we had 390 cases with simple scissors, bipolar and suturing with no ureteric injury. In 502 cases, new VSDs, e.g., plasma kinetic gyrus, Martin Maxim with Robi grasper, with or without harmonic 5 mm scalpel/ace were used. There were five ureteric injuries, all on the right side (one double ureter): first case was with Martin Maxim and Robi grasper, two with plasma kinetic gyrus 10 mm trissector, one with harmonic scalpel and the last one with scissors. We evaluated the reasons for such ureteric injuries, with experienced laparoscopic surgeons and the best possible set up. There were seven conversions to open surgery out of 892 cases of TLH, more due to poor case selection.

Total Laparoscopic Versus Vaginal Hysterectomy: A Retrospective Comparison

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

Robot-assisted laparoscopic hysterectomy: comparison with total laparoscopic hysterectomy

OBJECTIVE: To compare robot-assisted laparoscopic hysterectomy (RALH) with total laparoscopic hysterectomy (TLH). DESIGN: Prospective database and retrospective analysis. MATERIALS AND METHODS: Setting: Metropolitan hospital. Patients: One hundred and forty patients (60 TLH and 80 RALH) who underwent hysterectomy at a tertiary care center. Indications for surgery ranged from pelvic pain, abnormal uterine bleeding, and symptomatic uterine fibroids to endometrial adenocarcinoma, ovarian masses, and severe endometriosis. Interventions: The decision to use the da Vinci® robot was based on intra-operative findings and the presence of preceptees. All 140 patients had additional intra-abdominal procedures such as salpingo-oophorectomy, lysis of adhesions, treatment of endometriosis, appendectomy, Moschowitz procedure and ovariopexy. The unpaired t-test with a two-tailed P value (P < 0.05, CI 95%) was used for analysis. RESULTS: There was no statistical difference in the mean age (47 vs. 49), gravidy (1.5 vs. 1.9), number of previous laparoscopies (0.40 vs. 0.65) or laparotomies (0.73 vs. 0.55). There were no differences in the mean uterine weight (190 vs. 160 g) or EBL (67 vs. 66 ml), intraoperative (0.033 vs. 0.014) or postoperative (0.017 vs.0.063) complication rates. One patient with severe endometriosis in the TLH group had a ureterotomy repaired laparoscopically. One patient developed a uretero-peritoneal fistula that required laparoscopic repair several weeks later. In the RALH group, one patient with endometriosis of the bladder had a cystotomy which was repaired robotically. The patient developed urinary leakage 2 weeks postoperatively, suspicious for vesicovaginal fistula. It healed with an additional 2 weeks of bladder rest with Foley catheter. There were two cases of vaginal cuff bleeding and two cases of postoperative fever/atalectasis observed in the RALH group. CONCLUSIONS: Robot-assisted laparoscopic hysterectomy is safe and effective. It can be used to diminish the learning curve of laparoscopy. The robot offers an ergonomic, tremorless environment and 3-D visual field, helping to bridge the gap between laparotomy and laparoscopy.

Comparison of Three Hysterectomy Methods in a Set of Female to Male Transsexuals

Purpose: The aim of our study was to compare three widely used surgical techniques of hysterectomy in the well defined sub-population of patients undergoing hysterectomy - FtM transsexuals. Material and methods of investigation: Hysterectomy with bilateral adnexectomy was performed in 61 FtM transsexuals; patients were randomized into three categories: abdominal hysterectomy through a lower midline laparotomy (AHL), abdominal hysterectomy through a low transverse incision (AH), and total laparoscopic hysterectomy (TLH). Methods of assessing the results: The criteria studied were duration of surgery, blood loss and the length of post-operative hospitalization. The incidence of complications was also recorded. Results: Mean blood loss (136 ml) in the TLH patients was significantly lower than in either the AH (217 ml) or the AHL (226 ml) patients. Similarly, the length of post-operative hospitalization was significantly shorter for TLH (4.7 days) than for AH (6.4 days) and AHL (6.7 days). However, the duration of the surgery was significantly longer in TLH group (110 minutes) than with either the AH (55 minutes) or AHL (54 minutes). Differences between the AH and AHL procedures were not significant in any of the three studied criteria. Discussion, conclusions: In our set of patients TLH was associated with lower blood loss and shorter hospital stay compared to the laparotomic procedures and we found no post-operative complications in TLH patients. The only significant disadvantage was longer duration of TLH procedure compared to the open procedures. Based on our experience, we regard TLH as the method of choice in the surgical management of the FtM transsexuals.

Prospective comparison of tissue trauma after laparoscopic hysterectomy types with retroperitoneal lateral transsection of uterine vessels using ligasure and abdominal hysterectomy

The aim of this study was to evaluate the level of tissue trauma after laparoscopic and total laparoscopic hysterectomy with retroperitoneal lateral transsection of uterine vessels using ligasure as compared with abdominal hysterectomy. A total of 45 women with various indications for hysterectomy were randomized into laparoscopic hysterectomy, total laparoscopic hysterectomy and abdominal hysterectomy. Laparoscopic and total laparoscopic hysterectomy with retroperitoneal lateral transsection of uterine vessels was performed by four-puncture laparoscopy and pre-, postoperative and postoperative 24th hour levels of interleukin-6 (IL-6) and C-reactive protein (CRP), the mean operative time, drop in hemoglobin concentration, weight of removed uterus, VAS scores, hospitalization period and major and minor operative complications were analyzed prospectively. CRP and IL-6 levels were significantly higher in the abdominal hysterectomy group compared to either laparoscopy groups at the postoperative 24th hour. There were no significant differences in the levels of CRP and IL-6 between the two laparoscopy groups. The longest operative times were observed in the total laparoscopic hysterectomy group. Laparoscopic surgery causes less tissue trauma than the conventional open surgery; however, we observed no difference between the laparoscopic hysterectomy groups concerning the postoperative inflammatory response. We may prefer laparoscopic hysterectomy instead of total laparoscopic hysterectomy under suitable conditions, since laparoscopic hysterectomy causes the same level of tissue trauma as total laparoscopic hysterectomy, but has the advantage of a significantly shorter operative time. Meanwhile, hysterectomy done by laparoscopy with retroperitoneal lateral transsection of uterine vessels using ligasure is an effective and safe procedure.