Total laparoscopic hysterectomy, vaginal hysterectomy and total abdominal hysterectomy using electrosurgical bipolar vessel sealing technique: a randomized controlled trial

Allam, Ihab Serag; Makled, Ahmed Khairy; Gomaa, Ihab Adel; Bishry, Gasser El; Bayoumy, Hassan Awwad; Ali, Doaa Fouad

doi:10.1007/s00404-014-3571-3

Cited by 26 publications

(21 citation statements)

References 13 publications

(15 reference statements)

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“…With respect to the effect, the TLH group tends to have both lower rate of major surgical complications and lower rate of postoperative discomfort symptoms, and shorter LOS and shorter time back to normal actives compared to TAH. These findings are consistent with the empirical studies conducted elsewhere in the world [ 13 , 22 , 25 , 26 , 59 , 60 ]. Empirical studies from the US [ 26 , 61 ], the Netherlands [ 52 , 53 , 60 , 62 ], the UK [ 25 ] and China [ 63 ] all report that TLH had lower but insignificant complications rates compared to TAH.…”

Section: Discussionsupporting

confidence: 92%

Cost effectiveness analysis of total laparoscopic hysterectomy versus total abdominal hysterectomy for uterine fibroids in Western China: a societal perspective

Yang

Fan

Gao

et al. 2022

BMC Health Serv Res

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Background As a common female pelvic tumor, uterine fibroids remain the leading cause for hysterectomy in China. Hysterectomy provides a good surgical treatment of uterine fibroids, and it guarantees the removal of all uterine fibroids without lower risk of recurrence. This study compares the cost effectiveness of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) for women with uterine fibroids from a societal perspective. Methods An economic analysis was conducted in 392 patients (TLH n = 75; TAH n = 317), including all relevant costs over a 12-month time horizon. Primary outcome was major surgical complications; secondary outcomes were postoperative discomfort symptoms and time of return to normal activities. Clinical, outcomes and costs data were collected from medical records, telephone survey and financial information system. Generalized linear models were used to assess costs and outcomes differences between the two groups. Incremental cost effectiveness ratio (ICER) was used to estimate the cost effectiveness. Results Mean direct costs were $2,925.71 for TLH, $2,436.24 for TAH, respectively. Mean indirect costs were $1,133.22 for TLH, $1,394.85 for TAH, respectively. Incremental societal costs were $256.86 (95%CI: 249.03–264.69). Mean differences in outcome were: 4.53% (95%CI: 4.35–4.71) for major surgical complications; 6.75% (95%CI: 6.45–7.05) for postoperative discomfort symptoms; 1.27 (95%CI: 1.23–1.30) weeks for time to return to normal activities. ICER of TLH was $5,669.16 (95%CI: 5,384.76–5,955.56) per complication averted, $3,801.54 (95%CI: 3,634.81–3,968.28) per postoperative discomfort symptoms averted and $202.96 (95%CI: 194.97–210.95) per week saved to return to normal activities. Conclusions TLH is cost effective compared with TAH in preventing additional complications based on our estimated conservative threshold in China. The findings provide useful information for researchers to conduct further cost effectiveness analysis based on prospective study which can provide stronger and more evidence, in China. In addition, the data may be useful for Chinese health care policy-makers and medical insurance payers to make related health care decisions.

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Section: Discussionsupporting

confidence: 92%

Cost effectiveness analysis of total laparoscopic hysterectomy versus total abdominal hysterectomy for uterine fibroids in Western China: a societal perspective

Yang

Fan

Gao

et al. 2022

BMC Health Serv Res

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“…In the present study, the mean operative (64.7 min) time was shorter then reported in standard TLH (99.3 [15] and 126 min [16]). This is also less than reports by Kavallaris et al (80-90 min) and Mebes et al (90-111 min) [5,7].…”

Section: Discussioncontrasting

confidence: 66%

A novel approach to minimally invasive hysterectomy without the use of a uterine manipulator: Kamran’s TLH

Gendia¹,

Donlon²,

Kamran³

2021

Gynecol Surg

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Background Hysterectomy remains one of the most common major gynaecological procedures, with total laparoscopic hysterectomy (TLH) now established as the technique of choice over conventional open approaches. This approach depends on the use of a uterine manipulator to facilitate uterine retraction and colpotomy. This study describes a novel approach in performing total laparoscopic hysterectomy without the use of uterine manipulator or vaginal tubes and reports the intra- and postoperative outcome of this technique. Methods A single-centre retrospective analysis of patients who underwent TLH without uterine manipulator or vaginal tube “Kamran’s TLH” for benign conditions was performed from January 2017 to October 2019. Data collected included patients’ demographics, intraoperative finding and postoperative course. Results A total of eighty-six hysterectomies were performed utilizing the Kamran’s TLH (KTLH) approach. Mean age was 52.2 (± 11) years old and BMI was 28.2 (± 7). TLH with bilateral salpingo-oophorectomy was performed in 63 (73.3%) patients and TLH with preservation of ovaries in 23 (26.7%) patients. Mean operative time was 64.7 (± 27.9) min and estimated bloods loss was 46.2 (± 54.6) ml. No intraoperative complications were recorded and there was no conversion to open surgery. Only one patient required readmission and surgery for vaginal vault dehiscence during their postoperative course. Conclusion Uterine manipulator is a key component in performing laparoscopic hysterectomy. However, our approach demonstrated that TLH can be safely performed without the use of any uterine or vaginal manipulation.

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“…In the present study the mean operative (64.7 minutes) time was shorter then reported in standard TLH ( 99.3 [13] and 126 minutes [14]). The shorter operative time can be explained by the elimination of the time needed to apply uterine or vaginal manipulation.…”

Section: Discussioncontrasting

confidence: 64%

A Novel Approach to Minimally Invasive Hysterectomy Without the Use of a Uterine Manipulator; Kamran’s TLH.

Gendia

Waseem

Donlon

2020

Preprint

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Background: Hysterectomy remains one of the most common major gynaecological procedure, with total laparoscopic hysterectomy (TLH) now the established as the technique of choice over conventional open approaches. This approach depends on the use of a uterine manipulator to facilitate uterine retraction and colpotomy. This study describes a novel approach in performing total laparoscopic hysterectomy without the use of uterine manipulator or vaginal tubes and reports the intra- and post-operative outcome of this technique.Methods: A single centre retrospective analysis of patients who underwent TLH without uterine manipulator or vaginal tube “Kamran’s TLH” for benign conditions was performed from January 2017 to October 2019. Data collected included patients demographics, intraoperative finding and postoperative course.Results: A total of eighty six hysterectomies were performed utilizing the Kamran’s TLH (KTLH) approach. Mean age was 52.2 (±11) years old and BMI was 28.2(±7). TLH with bilateral salpingo-oophorectomy was performed in 63(73.3%) patients and TLH with preservation of ovaries in 23 (26.7%) patients. Mean operative time was 64.7(±27.9) minutes and estimated bloods loss was 46.2(±54.6) ml. No intraoperative complications were recorded and there was no conversion to open surgery. Only one patient required readmission and surgery for vaginal vault dehiscence during their postoperative course.Conclusion: Uterine manipulator is a key component in performing laparoscopic hysterectomy. However, our approach demonstrated that TLH can be safely performed without the use of any uterine or vaginal manipulation.

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Total laparoscopic hysterectomy, vaginal hysterectomy and total abdominal hysterectomy using electrosurgical bipolar vessel sealing technique: a randomized controlled trial

Abstract: TLH had a longer operation time, yet, less blood loss, shorter hospital stay, less postoperative pain and fewer complications, compared to TAH and VH using EBVS.

Cited by 26 publications

References 13 publications

Cost effectiveness analysis of total laparoscopic hysterectomy versus total abdominal hysterectomy for uterine fibroids in Western China: a societal perspective

Cost effectiveness analysis of total laparoscopic hysterectomy versus total abdominal hysterectomy for uterine fibroids in Western China: a societal perspective

A novel approach to minimally invasive hysterectomy without the use of a uterine manipulator: Kamran’s TLH

A Novel Approach to Minimally Invasive Hysterectomy Without the Use of a Uterine Manipulator; Kamran’s TLH.

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