Total Laparoscopic Hysterectomy: Retrospective Analysis of 262 Cases

Cristina Nogueira-Silva, Samuel Santos-Ribeiro, Sónia Barata, Conceição Alho, Filipa Osório, Carlos Calhaz-Jorge

Abstract


Introduction: Hysterectomy is one of the most common gynecological procedures and may be performed either by vaginal approach, laparotomy or laparoscopy. Although total laparoscopic hysterectomy has multiple advantages, conflicting major complication rates have been previously reported.
Objectives: To describe our experience performing TLH and to evaluate complication rates.
Material and Methods: A retrospective observational study of all total laparoscopic hysterectomy performed in our department, by the same surgical team, between April 2009 and March 2013 (n = 262), was conducted. Medical records were reviewed for patient characteristics, operating time, uterine weight, post-operative hemoglobin variation, length of hospital stay, and intra and postoperative complications.
Results: Patient average age was 48.9 ± 9.0 years and 49.2% had previous abdominopelvic surgery. The average body mass index was 26.5 ± 4.5 kg/m2 and 42% of women were either overweight or obese. The mean operating time during the total study period was 77.7 ± 27.5 minutes, but it decreased significantly as the surgical team’s training increased. Average uterine weight was 241.0 ± 168.4g and average hospital stay was 1.49 ± 0.9 days. The mean postoperative hemoglobin variation was -1.5 ± 0.8g/dL. The major and minor complication rates were 1.5% (n = 4) and 11.5% (n = 30), respectively. One procedure was converted to laparotomy and two women
had a vaginal vault dehiscence. No important urinary tract or bowel injuries occurred.
Conclusions: This study demonstrates that, in experienced hands, total laparoscopic hysterectomy is safe and with low complications rates.

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