A randomised prospective trial comparing laparoscopic and abdominal hysterectomy

Abstract

Objective To compare short term clinical results in a prospective randomised trial of laparoscopic hysterectomy compared with abdominal hysterectomy. Methods One hundred and forty‐three women scheduled for total abdominal hysterectomy, with or without salpingo‐oophorectomy and with a maximum uterine width of less than 11 cm, were prospectively randomised to undergo the procedure by laparoscopic hysterectomy (n= 71) or abdominal hysterectomy (n= 72). During laparoscopic hysterectomy, the uterine arteries as well as the upper portion of the cardinal ligaments were transected laparoscopically. The perioperative and post‐operative courses of the groups were compared. Results The number of women with a complication did not differ significantly between laparoscopic hysterectomy (27%) and abdominal hysterectomy (33 %) groups. The post‐operative fall in erythrocyte volume fraction was significantly greater following abdominal hysterectomy (5.6% compared with 4.1 % median value, P 0.001). Post‐operative pain, assessed by the patients two days after surgery on a visual analogue scale, was significantly higher following abdominal hysterectomy (4.2 compared with 3.6 units median value, P < 0.05). Although laparoscopic hysterectomy took longer (148 min compared with 85 min median value, P < 0.001), the women undergoing this procedure had a shorter post‐operative time in hospital (two compared with four days median value, P < 0.001) and a shorter convalescence (16 compared with 35 days median value, P < 0.001). Conclusions Laparoscopic hysterectomy is a safe procedure for selected patients scheduled for abdominal hysterectomy, and offers benefits to the patients in the form of less operative bleeding, less post‐operative pain, shorter time in hospital and shorter convalescence time.

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

“…24 The complication rate in our series compares favorably with rates reported in the literature. 9,11,[25][26][27][28] We had no instances of major hemorrhage, ureteric injury or bowel injury. Major complications were bladder injury (2%), rate of which were similar to those reported in other studies.…”

“…Major complications were bladder injury (2%), rate of which were similar to those reported in other studies. 9,22,[25][26][27][28] A study in France, in which 29 of 416 (7%) of TLH cases were converted to laparotomy, determined that increased body mass index, uterine width more than 10 cm and adhesions from previous abdominal and pelvic surgery were predictive factors for laparotomy. 29 Although our data do not show an association between a history of pelvic surgery, caesarian section or increased body weight and a higher risk of conversion to laparotomy, significant conclusions cannot be made because of the retrospective nature of our study and the relatively small number of subjects.…”

Laparoscopic Assisted Vaginal Hysterectomy: A Case Control Comparative Study with Total Abdominal Hysterectomy

“…Laparoscopic hysterectomy has never been indicated for hysterectomy if the operation is feasible by the vaginal route. Much effort have been put into randomized control trials which compares laparoscopically assisted vaginal hysterectomy (LAVH) and total abdominal hysterectomy 3,4 .…”

Analytical study of hysterectomies

“…5 Also the increase in hysterectomies may be due to prophylaxis against uterine cancer, in cases of mild genital prolapse and premenopausal menorrhagia. 6 Hysterectomy must never be done without proper indications. According to Dicker, hysterectomy is indicated when the risk of preserving the uterus is greater than the risk of its removal or when medical treatment is not successful in relieving the disabling symptoms.…”