Feasibility and Safety of Outpatient Total Laparoscopic Hysterectomy

Abstract

Background and Objective:Ambulatory total laparoscopic hysterectomy (TLH) could lead to significant cost savings, but some fear the effects of what could be premature postsurgical discharge. We sought to estimate the feasibility and safety of TLH as an outpatient procedure for benign gynecologic conditions.Methods:We report a prospective, consecutive case series of 128 outpatient TLHs performed for benign gynecologic conditions in a tertiary care center.Results:Of the 295 women scheduled for a TLH, 151 (51%) were attempted as an outpatient procedure. A total of 128 women (85%) were actually discharged home the day of their surgery. The most common reasons for admission the same day were urinary retention (19%) and nausea (15%). Indications for hysterectomy were mainly leiomyomas (62%), menorrhagia (24%), and pelvic pain (9%). Endometriosis and adhesions were found in 23% and 25% of the cases, respectively. Mean estimated blood loss was 56 mL and mean uterus weight was 215 g, with the heaviest uterus weighing 841 g. Unplanned consultation and readmission were infrequent, occurring in 3.1% and 0.8% of cases, respectively, in the first 72 hours. At 3 months, unplanned consultation, complication, and readmission had occurred in a similar proportion of inpatient and outpatient TLHs (17.2%, 12.5%, and 4.7% versus 18.1%, 12.7%, and 5.4%, respectively). In a logistic regression model, uterus weight, presence of adhesions or endometriosis, and duration of the operation were not associated with adverse outcomes.Conclusion:Same-day discharge is a feasible and safe option for carefully selected patients who undergo an uncomplicated TLH, even in the presence of leiomyomas, severe adhesions, or endometriosis.

Outpatient vs inpatient total laparoscopic hysterectomy: A randomized controlled trial

“…These patients experienced more pain and were more dissatisfied, and the number may correspond to clinical reality when LH is routinely performed as an outpatient procedure in settings where treatment is free of cost for the patient. As expected, we found no difference in complication and readmission rates, in agreement with previous studies on outpatient TLH . The complication rate at 12% is equivalent to the national level in Denmark .…”

“…To our knowledge this is the first RCT examining patient satisfaction in patients undergoing outpatient TLH as a routine. In selected women, outpatient TLH was associated with same‐day discharge rates between 85% and 100% . Studies investigating predictors and rates of readmissions after outpatient LH found same‐day discharge rates between 20% and 34% after TLH .…”

“…Laparoscopic hysterectomy (LH) is a safe procedure with low risk of complications and short hospital stay. Readmission rates as low as <4% are reported within the first 4 weeks . The minimal invasive technique has added to the possibility of same‐day discharge owing to the well being of the patients.…”

“…The minimal invasive technique has added to the possibility of same‐day discharge owing to the well being of the patients. In the literature, LH is performed as an outpatient procedure with high patient satisfaction in selected materials, but data on outpatient LH as a routine procedure are sparsely reported . A previous randomized controlled trial (RCT) on outpatient laparoscopic supracervical hysterectomy (LASH) showed no significant reduction in patient satisfaction, but the data might reflect less optimal results.…”

“…It is therefore possible that routine outpatient LH may imply impaired patient satisfaction . Expected advantages are faster recovery in the home environment and an economic benefit at healthcare and societal level with faster return to work …”