Minimally invasive hysterectomy for benign disease: our experience study
Keywords:Laparoscopic hysterectomy, Vaginal route, Postoperative
Background: The incidence of hysterectomy in India ranges from 7-8 % and 60% of major gynaecological surgeries are hysterectomies at government teaching institutions. The objective of this study was to assess feasibility and safety of laparoscopic hysterectomy.
Methods: It was a retrospective case series. Study duration was two years. Setting was at Cama and Albless hospital which is a government hospital affiliated to grant medical college, Mumbai. Cases with benign indication for hysterectomy were which were unsuitable for vaginal approach were assessed and those deemed suitable for laparoscopic approach were selected. Total laparoscopic approach was used to perform hysterectomy. Patient demographics and outcome measures were analyzed. Outcome measures included duration of surgery, length of postoperative stay, estimated blood loss, complication rate and laparotomy conversion rates.
Results: It was a two year study period. Total number of women who underwent hysterectomies during this period for benign indications were 303, out of which 146 were done by vaginal route, 126 by abdominal route and the remaining 35 (22%) were done by laparoscopic route. Main indication was dysfunctional uterine bleeding not responding to medical management. Median age of patients was 43 years, majorities were parous and none of them were obese. Uterine size ranged from normal size to 16 weeks. Duration of surgery was between 1.5-2.5 hours with an estimated blood loss of less than 100 ml in 2/3rd of them. Median duration of postoperative stay was 7 days. The major complication and laparotomy conversion and readmission rates were nil.
Conclusions: Laparoscopic hysterectomy was well accepted and was found to feasible and safe in our setting.
Singh A, Arora AK. Why hysterectomy rate are lower in India? Indian Journal of Community Medicine. 2008;33(3):196-7.
Desai S, Sinha T, Mahal A. Prevalence of hysterectomy among rural and urban women with and without health insurance in Gujarat, India. Reproductive Health Matters. 2011;19(37)42-51.
Pandey D, Sehgal K, Saxena A, Hebbar S, Nambiar J, Bhat RG. An audit of indications, complications, and justification of hysterectomies at a teaching hospital in India. International Journal of Reproductive Medic Volume. 2014:279273:6.
Johnson N, Barlow D, Lethaby A, Tavender E, Curr E, Garry R. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2006;19(2):CD003677.
Meikle SF, Nugent EW, Orleans M. Complications and recovery from laparoscopy-assisted vaginal hysterectomy compared with abdominal and vaginal hysterectomy. Obstet. 1997;89(2):304-11.
Davies A, Vizza E, Bournas N, O'Connor H, Magos A. How to increase the proportion of hysterectomies performed vaginally. Am J Obstet Gynecol. 1998;179(4):1008-12.
Reich H. Total laparoscopic hysterectomy: indications, techniques and outcomes. Curr Opin Obstet Gynecol. 2007;19:337-44.
Einarsson JI, Suzuki Y. Total laparoscopic hysterectomy: 10 steps toward a successful procedure. Rev Obstet Gynecol. 2009;2(1):57-64.
Mukhopadhaya N, Manyonda IT. The hysterectomy story in the United Kingdom. J Midlife Health. 2013;4(1):40-1.
Broder MS, Kanouse DE, Mittman BS, Bernstein SJ. The appropriateness of recommendations for hysterectomy. Obstetrics and Gynecology. 2000;95(2):199-205.
Qamar-Ur-Nisa H, Habibullah, Memon F, Shaikh TA, Memon Z. Hysterectomies: an audit at a tertiary care hospital. The Professional Medical Journal. 2011;18(1):46-50.
Olive DL, Parker WH, Cooper JM, Levine RL. The AAGL classification system for laparoscopic hysterectomy. J Am Assoc Gynecol Laparosc. 2000;7(1):9-15.
Krebs HB, Helmkamp BF. Transverse periumbilical incision in the massively obese patient. Obstet Gynecol. 1984;63:241-5.
Pitkin RM. Abdominal hysterectomy in obese women. Surg Gynecol Obstet. 1976;142:532-6.
Nawfal AK, Orady M, Eisenstein D, Wegienka G. Effect of body mass index on robotic-assisted total laparoscopic hysterectomy. J Minim Invasive Gynecol. 2011;18(3):328-32.
O'Hanlan KA, Lopez L, Dibble SL, Garnier AC, Huang GS, Leuchtenberger M. Total laparoscopic hysterectomy: body mass index and outcomes. Obstet Gynecol. 2003;102(6):1384-92.
Pol G, Bobin L, Maciołek-Blewniewska G, Malinowski A. Operating time of laparoscopically assisted vaginal hysterectomy (LAVH) the causative factors and the course of the postoperative period. Ginekol Pol. 2007;78(3):204-9.
Clayton RD. Hysterectomy. Best Pract Res Clin Obstet Gynaecol. 2006;20(1):73-87.
Leonard F, Chopin N, Borghese B, Fotso A, Foulot H, Coste J, et al. Total laparoscopic hysterectomy: preoperative risk factors for conversion to laparotomy. J Minim Invasive Gynecol. 2005;12(4):312-7.
Wattiez A, Soriano D, Cohen SB, Nervo P, Canis M, Botchorishvili R, et al. The learning curve of total laparoscopic hysterectomy: comparative analysis of 1647 cases. J Am Assoc Gynecol Laparosc. 2002;9(3):339-45.
Aniuliene R, Varzgaliene L, Varzgalis M. A comparative analysis of hysterectomies. Medicina Kaunas. 2007;43(2):118-24.