Total laparoscopic tube hysterectomy: a safer option?

Abstract

Objective To compare outcomes in women undergoing total laparoscopic hysterectomy performed with the assistance of a colpotomizing tube (TLTH), with those in women in whom a laparoscopically assisted hysterectomy (LAH) procedure was performed. Design A retrospective review of consecutive patients. Setting State health service patients were treated at Flinders Medical Centre, Adelaide, South Australia, and private patients were treated by the same surgeons in three private hospitals in metropolitan Adelaide. Subjects A total of 227 women who underwent operation between January 1996 and August 1999. Interventions The women involved in the first two years of this study exclusively underwent an LAH, whilst those in the latter 18 months underwent a TLTH. Main outcome measures These included intraoperative complications, including significant haemorrhage, ureteric, bladder, vascular and bowel injury; postoperative complication rates for vault infection, late bowel and ureteric injury, and miscellaneous febrile morbidity. Also documented were the operating time, nonautologous blood transfusion, operation–discharge interval, and readmission with a complication. Results The women having the TLTH procedure had significantly fewer intraoperative complications (χ2 = 8.07, P = 0.004) in comparison with the LAH group; postoperative complications were not statistically different. The mean operating times and readmission rates with surgical complications were equivalent for the two groups. The hospital stay was shorter by 1.5 days for the women having a TLTH (t = 8.39, P < 0.001), and the estimated blood loss was less than half of that for the LAH patients (t = 8.94, P < 0.001); nonautologous blood transfusion was not needed in either group. Conclusion Total laparoscopic hysterectomy utilizing the nondisposable colpotomizing tube and uterine manipulator has both fewer intraoperative complications and reduced blood loss when compared with laparovaginal hysterectomy, and is a safe alternative to LAH.

Total laparoscopic hysterectomy in 1253 patients using an early ureteral identification technique

“…3,4 Proponents of the procedure, however, have gained sufficient experience that this is currently their preferred technique for hysterectomy. 5,6 A meta-analysis of 27 randomized trials indicated that the advantages of laparoscopic gynecologic surgery over abdominal include: decreased pain, fewer surgical site infections, shorter hospital stay, quicker return to activity, and a lower incidence of postoperative adhesions. 7 Although the complications of TLH have been described several times, many of these studies were limited to TLH for specific indications.…”

Retrospective study of the success rates and complications associated with total laparoscopic hysterectomy

“…Proponents have gained so much experience that it is currently their preferred technique for hysterectomy. [4][5][6] The sub-classification of laparovaginal hysterectomy is dependent on the method of securing and dividing the uterine artery. 7 Laparoscopic hysterectomy (LH) refers to the laparoscopic division of the uterine vessels.…”

Routine cystoscopy after laparoscopically assisted hysterectomy: what's the point?

“…Laparoscopic hysterectomy has been associated with a higher rate of ureteric injury than open and vaginal hysterectomy 1 . The practice of screening cystoscopy following laparoscopic hysterectomy has become widespread, 2,3 with the aim of improving patient outcomes by the early diagnosis and treatment of ureteric injuries. However, cases of normal findings on cystoscopic examination with subsequent detection of ureteric injuries 4 have caused concern and raised doubt about the value of screening cystoscopy in this context.…”