Intraoperative complications after total laparoscopic hysterectomy: a retrospective study in training institute
Keywords:Hysterectomy, Intraoperative complications, TLH
Background: Hysterectomy is a common gynecological surgery performed in premenopausal and menopausal age group. Different types of approaches are there with their advantages and disadvantages, it is mainly indicated for noncancerous conditions. Till today three different surgical approaches to hysterectomy are available: vaginal, abdominal and laparoscopic. TLH has been reported to result in shorter procedure durations, lower blood losses, and shorter hospital stays.
Methods: This is a retrospective case study, was carried out over a 5-year period in a tertiary care institute. Study done on patients attending gynecology OPD at our tertiary care institute during the period since September 2013 to September 2018.
Results: In present study out of 646 endoscopic hysterectomies in last five years authors studied 420 Total Laparoscopic Hysterectomies. Conversion to open surgery rate was 0.3%. Mean age was 49.26 years (SD-9.53), Performed for various indications with various BMI patients. Mean surgical duration was 116.55 minutes with SD 26.27. Major complication rate was 2.85% with 2 cases of bowel injuries and 3 cases of urological injuries.
Conclusions: Total laparoscopic hysterectomy appears safe and effective approach for variety of indications with minimal morbidity. Beneficial for all age group all nulliparous /multiparous patients as well as obese patients. With the knowledge of all complication and its prevention, maximum surgeons can give benefit of advantages of total laparoscopic hysterectomy to all women. More and more randomized clinical trials will motivate surgeons for this approach.
Baskett TF. Hysterectomy: evolution and trends. Best Pract Res Clin Obstet Gynaecol 2005; 19(3):295-305.
Lau WY, Leow CK, Li AK. History of Endoscopicand Laparoscopic surgery. World J Surg 1997; 21(4):444-53.
Himal HS. Minimally invasive (laparoscopic) surgery. Surg Endosc 2002; 16(12):1647-52.
Clayton RD. Hysterectomy. Best Pract Res Clin Obstet Gynaecol 2006;20:73-87.
H Rkki-Sirén P. Laparoscopic hysterectomy. Outcomeand complications in Finland. [doctoral thesis]. Helsinki: Medical Faculty University of Helsinki;1999.
Reich H, DeCaprio J, McGlynn F. Laparoscopichysterectomy. J Gynecol Surg 1989; 5(2):213-6.
Nezhat C, Nezhat F, Admon D, Nezhat AA. Proposed classification of hysterectomies involving laparoscopy. J Am Assoc Gynecol Laparosc. 1995;2(4):427-9.
Lee PI, Lee YT, Lee SH, Chang YK. Advantages of total laparoscopic hysterectomy. J Am Assoc Gynecol Laparosc.1996;3(4):S24-5.
Hasson HM, Rotman C, Rana N, Asakura H. Experience with laparoscopic hysterectomy. J Am Assoc Gynecol Laparosc.1993;1(1):1-11.
O’Hanlan KA, Huang GS, Lopez L, Garnier AC. Total laparoscopic hysterectomy for oncological indications with outcomes stratified by age. Gynecol Oncol.2004;95(1):196-203
O’Hanlan KA, Huang GS, Lopez L, Garnier AC. Selective incorporation of total laparoscopic hysterectomy for adnexal pathology and body mass index.Gynecol Oncol.2004;93(1):137-43.
Johnson N, Barlow D, Lethaby A, Tavender E, Curr E, Garry R. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database SystRev.2005(1):CD003677.
O’Hanlan AK, Dibble SL, Garnier AC, Reuland LM, J Soc Laparo endoscopic Surg JSLS (2007)11:45-53.
Hoffman CP, Kennedy J, Borschel L, Burchette R, Kidd A. Laparoscopic hysterectomy: the Kaiser Permanente San Diego experience. J Minimal Invas Gynecol. 2005;12(1):16-24.
Chapron C, Dubuisson JB, Ansquer Y, Fernandez B. Totalhysterectomy for benign pathologies. Laparoscopic surgery does not seem to increase the risk of complications. J Gynecol Obstet Biol Reprod (Paris).1998;27(1):55-61.
Heinberg EM, Crawford BL, Weitzen SH, Bonilla DJ. Total laparoscopic hysterectomy in obese versus nonobese patients. Obstet Gynecol. 2004;103(4):674-80.