Clinical outcomes of 1,041 total laparoscopic hysterectomies: Six years of experience in a single center

Abstract

ObjectiveTo evaluate the association between outcomes of total laparoscopic hysterectomy (TLH) and patient demographic and clinical factors. MethodsThe present study was performed on a total of 1,041 women who underwent TLH, with or without bilateral/unilateral salpingooophorectomy, from May 2003 to December 2008, excluding patients who also underwent other procedures simultaneously, including ovarian cystectomy, colporrhaphy, incontinence surgery, pelvic/para-aortic lymph node dissection, and/or omentectomy. The medical records were reviewed and clinical outcomes were analyzed. ResultsMean patient age was 46.6 ± 13.4 years, mean operation time was 103.4 ± 42.3 minutes, and mean duration of total hospital stay was 5.4 ± 2.9 days. The mean decrease in hemoglobin concentration from before operation to 1 day after surgery was 1.4 ± 0.9 g/ dL, and one patient required an intraoperative transfusion. The main diagnosis was leiomyoma including concomitant adenomyosis (62.2%), followed by adenomyosis (16.0%) and 32 early stage gynecologic malignancies including 20 patients with microinvasive cervical cancer, 10 with endometrial cancer, 1 with borderline ovarian cancer, and 1 with uterine sarcoma. Laparotomy conversion was occurred in 45 patients (4.2%), because of severe pelvic/abdominal adhesion or huge uterine size. Large uterine size was associated with a signifi cantly higher rate of conversion (7.9% vs. 2.6%, P < 0.01), and a signifi cantly longer operation time (110.5 minutes vs. 93.1 minutes vs. 95.3 minutes, P < 0.01). Overall, 6 patients (0.6%) experienced major complications, including two bowel perforations, two ureteral injuries requiring surgical repair, one vaginal evisceration, and one incisional hernia. ConclusionTLH is a safe and acceptable alternative to standard hysterectomy for various indications, including malignancy. Hysterectomy is the most common operation in gynecology. For example, one-third of American women will have undergone a hysterectomy by age of 65 years [1], and 20% of women in the United Kingdom will have undergone a hysterectomy by age of 55 [2]. Several surgical techniques are currently utilized for hysterectomy, including total abdominal hysterectomy (TAH), vaginal total hysterectomy, and total laparoscopic hysterectomy (TLH), with the proportion of patients treated with the latter operation increasing. In our institute, the proportion of TLH has increased from 59% in 2003 to 74% in 2008. This increase is attributable to the de-ORIGINAL ARTICLE Korean J Obstet Gynecol 2011;54(10):618-622 http://dx

Clinical Outcomes of Total Laparoscopic Hysterectomy (TLH): Seven Years’ Experience in a Public Hospital

“…The demographic data including age, parity and body mass index were similar to other studies 16,17 . The most common indication for TLH in our study was leiomyoma (51.7%) which is similar to the study done by Moon 18 and Begum 19 .…”

“…Although the laparoscopic hysterectomy techniques were not identical in all series, our results are nevertheless comparable with those already published regarding operative time, hospital stay, major complications and rate of conversion ( Table 6) 13,[16][17][18][19]28 .…”

Histopathological evaluation of endometrial sampling in different age groups - 1374 cases

“…The most common indication for hysterectomy in gynecological surgery is leiomyoma 25 . In some of the studies, no malignancy was detected in samplings performed for myoma uteri 5,6 .…”

Laparoscopic hysterectomy in frozen pelvis—an alternative technique of retrograde adhesiolysis

“…Laparoscopic hysterectomy in frozen pelvis facilitates adnexa removal compared to vaginal hysterectomy as the adnexa may be adherent to surrounding structures that may be extremely difficult to reach transvaginally [9]. The laparotomy conversion rate for laparoscopic hysterectomy in severe endometriosis and large fibroids as described in literature is 4.3 and 7.9 % [8,11]. In our series, one patient had conversion to laparotomy.…”