Comparison of the different types of “laparoscopic total hysterectomy”

Leung, Siu Ling; Chan, Chung Sum; Lo, S. F.; Pang, Chung Pui; Pun, Ting-Chung; Yuen, Pong Mo

doi:10.1016/j.jmig.2006.09.003

Cited by 10 publications

(4 citation statements)

References 15 publications

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“…In addition, the vast majority were multicenter studies that were biased by different expertise of the surgeons (9-13). A recent multicenter study by Leung WS et al, (14) reported that TLH resulted in longer operating times compared to LH, as was confirmed in our study. Interestingly, these authors reported more intraoperative blood loss in LH than in TLH.…”

Section: Discussionsupporting

confidence: 91%

“…However, in our study we showed that the amount of intraoperative bleeding was significantly less in the LH group compared to that of the TLH.group This could be due to use of Ligasure tm in the present study. Another interesting outcome in the study of Leung WS et al, (14) was that patients in the LH group had higher vaginal cuff hematoma incidence compared to patients in the TLH group. In our study, we did not see a single case of postoperative vaginal cuff hematoma in either group.…”

Section: Discussionmentioning

confidence: 94%

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

Göl

Kizilyar²

2010

J Turkish German Gynecol Assoc

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Objective: The aim of this study was to compare the efficacy and safety of laparoscopic hysterectomy (LH) and Total Laparoscopic Hysterectomy (TLH).Methods: 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. Results: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. Abstract Özet Conclusion

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 94%

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

Göl

Kizilyar²

2010

J Turkish German Gynecol Assoc

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“…Other rare complications varied between studies and ranged from 0.1% for venous thromboembolism [7] to 0.7% for pulmonary embolism and 0.7% for deep vein thrombosis [10], similar to the RCT by Garry et al [4]. Vaginal vault dehiscence is thought to be higher in hysterectomies performed via the laparoscopic route [14] and quoted as 1.14% using this route.…”

mentioning

confidence: 68%

“…Although the data collection was from 1993 and 1994 and therefore experience and technique of laparoscopic hysterectomy has changed, modifying the complication rates, this was a well-designed and conducted prospective series, which described complications as its endpoint and with a considerable number of patients at follow-up. This rate dropped to 0.34% in a 6-year retrospective case series review performed in the same country, probably when proficiency was reached [8].Conversely, the bladder lacerations are quoted below 2%, varying between 0.3-0.4% in retrospective reviews [5,6,9] and almost 1.5% in prospective cohorts [7,10]. A meta-analysis of three randomized controlled trials (RCTs) of TLH and TAH showed significantly more total complications in the TAH group and no difference concerning the urinary tract injuries [11], similar to the RCT by Marana of LAVH and TAH [12].…”

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confidence: 92%

Laparoscopic hysterectomy: should the complications redefine the classification?

et al. 2010

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The laparoscopic route for the removal of uteri for benign conditions represents a well-established surgical route over the last 20 years, gaining popularity throughout the world. The modifications of the original technique and the variable involvement of the laparoscopic component necessitated the description of this surgical procedure, and therefore, classification systems were introduced. An attempt was hence made to standardize laparoscopic hysterectomy so that we all understand the same meaning when we describe a specific type. This standardization, however, has not incorporated factors such as simplicity, different types of energy use, and complications that have to be audited to a set standard that probably does not exist yet, due to the variable complication rates in the literature. We look into the different major proposed classification systems and their benefits and drawbacks and try to redefine a system that is simple to use and may improve our audit purposes. In order to achieve this, we review the complications of laparoscopic hysterectomy in the literature, using the Cochrane collaboration, the Medline, and Embase databases.Keywords Laparoscopic hysterectomy . Laparoscopically assisted vaginal hysterectomy . Total laparoscopic hysterectomy . Complications . Classification Laparoscopic hysterectomy (LH) and laparoscopically assisted vaginal hysterectomy (LAVH) represent an approach to the removal of uteri for benign and malignant gynecological diseases that has been evolving the last 20 years [1]. The slow uptake in this approach to hysterectomy may be due to variable complication rates and training necessary to standardize this procedure and reduce complications [2].The surgical approach to hysterectomy was also addressed by the Cochrane collaboration which found complication rates in the laparoscopic groups to be variable [3]. Comparisons were made with vaginal (VH) and abdominal hysterectomies (AH) in different groups and complications were categorized in primary and secondary. All urinary tract injuries were higher in the LH group when compared to AH and in the total LH (TLH) when compared to the VH groups with more intraoperative bleeding and postoperative blood transfusions in the LH versus the VH modalities, thereby Cochrane review shed some light in the subject of benefits and risks associated with LH. The individual bladder and ureteric injuries though, when LH and AH were compared did not reach statistical significance, when the confidence intervals of the odds ratios were seen. Similar findings were observed in the LH to VH arm, with even no significant increase, with regards to LH, in the combined ureteric and bladder injuries. The only group that showed statistical significance was the comparison of TLH to VH, where the combined urinary tract injuries favored the VH. This subgroup consisted of two studies, one underpowered showing no statistical significance and the randomized controlled trial by Morelli et al. describing 12 urinary tract injuries in 200 women who had LH, a 6% occurrenc...

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Clinical Relevance of Conversion Rate and its Evaluation in Laparoscopic Hysterectomy

Twijnstra

Blikkendaal

Zwet

et al. 2013

Journal of Minimally Invasive Gynecology

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Comparison of the different types of “laparoscopic total hysterectomy”

Cited by 10 publications

References 15 publications

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

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

Laparoscopic hysterectomy: should the complications redefine the classification?

Clinical Relevance of Conversion Rate and its Evaluation in Laparoscopic Hysterectomy

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