Outcome of total laparoscopic hysterectomy in relation to the size of the uterus
Keywords:Blood Loss, Complications, Operative Time, Pain Score, Size of Uterus, TLH
Background: Laparoscopic hysterectomy is a safe and feasible technique to manage benign uterine pathology as it offers minimal postoperative discomfort; with shorter hospital stay, rapid convalescence and early return to the activities of daily living. However, to date very few studies have been reported on safety and feasibility of total laparoscopic hysterectomy (TLH) in large sized uteri. The present study was planned to evaluate the intra-operative and post-operative parameters in relation to size of the uterus during TLH.
Methods: This study was a comparative study. Fifty women with uterine size less than 12 weeks (Group 1) and fifty women with uterine size more than or equal to 12 weeks (Group 2) for whom TLH was planned for benign indications were included in the study. Intra-operative and post-operative parameters like blood loss, duration of surgery, post-operative pain and complications were compared between the two groups. Comparison was done using independent sample t test. A probability (‘p’ value) of less than or equal to 0.05 at 95% confidence interval was considered as statistically significant.
Results: The mean age of the patients in both the groups was matched (44.82 years vs. 43.96 years). The mean operative time (48.80±14.12 minutes vs. 77.3±35.11 minutes; p <0.001) and blood loss (40.10±18.25ml vs. 70.6±65.46 ml; p=0.002) were significantly high in Group 2 compared to Group 1. The mean pain scores were similar in both the groups at 6 hours, 24 hours and at the time of discharge. No significant complications were noted in both the groups.
Conclusions: TLH is safe, feasible and acceptable for large size uterus (>12 weeks). However, it is associated with longer operative time, and greater amount of blood loss.
Shetty J, Shanbhag A, Pandey D. Converting potential abdominal hysterectomy to vaginal one: laparoscopic assisted vaginal hysterectomy. Minimally Invasive Surgery. 2014;2014.
Singh AJ, Arora AK. Effect of uterine prolapse on the lives of rural north Indian women. Singapore J Obstet Gynecol. 2003;34(2):52-8.
Kumar GS, Lekkala S. Complications after a total laparoscopic hysterectomy: a study in tertiary care unit in Telangana, India. Int Surg J 2016;3(3):1141-5.
Bonilla DJ, Mains L, Rice J, Crawford III B. Total laparoscopic hysterectomy: our 5-year experience (1998–2002). T Ochsner J. 2010;10(1):8-12.
Johnson N, Barlow D, Lethaby A, Tavender E, Curr E, Garry R. Surgical approach to hysterectomy for benign gyneacological disease. Cochrane Database Syst Rev. 2006;2(2):CD003677.
Wattiez A, Soriano D, Fiaccavento A, Canis M, Botchorishvili R, Pouly J, et al. Total laparoscopic hysterectomy for very enlarged uteri. J Am Assoc Gynecol Laparosc. 2002;9(2):125-30.
Sinha R, Sundaram M, Lakhotia S, Mahajan C, Manaktala G, Shah P. Total laparoscopic hysterectomy for large uterus. J Gynec Endosc Surg. 2009;1(1):34-9.
Reich H. Total laparoscopic hysterectomy: indications, techniques and outcomes. Curr Opin Obstet Gynecol. 2007;19(4):337-44.
Kehde BH, van Herendael BJ, Tas B, Jain D, Helsen K, Jochems L. Large uterus: what is the limit for a laparoscopic approach? Autops Case Rep. 2016;6(1):51-6.
Kondo W, Zomer MT, Charles L, Bourdel N, Mage G, Canis M. Total laparoscopic hysterectomy: surgical technique and results. InAdvanced Gynecologic Endoscopy 2011. InTech.
Yavuzcan A, Çağlar M, Üstün Y, Dilbaz S, Kumru S. Evaluation of the outcomes of laparoscopic hysterectomy for normal and enlarged uterus (> 280 g). Arch Gynecol Obstet. 2014;289(4):831-7.
Wang CJ, Yen CF, Lee CL, Tashi T, Soong YK. Laparoscopically assisted vaginal hysterectomy for large uterus: a comparative study. European Journal of Obstet Gynecol Reproduct Biol. 2004;115(2):219-23.
Macciò A, Chiappe G, Kotsonis P, Nieddu R, Lavra F, Serra M, et al. Surgical outcome and complications of total laparoscopic hysterectomy for very large myomatous uteri in relation to uterine weight: a prospective study in a continuous series of 461 procedures. Arch Gynecol Obstet. 2016;294(3):525-31.