Assessment of the learning curve: total laparoscopic hysterectomy versus total abdominal hysterectomy
Keywords:Total abdominal hysterectomy, Total laparoscopic hysterectomy
Background: Abdominal hysterectomy is the most frequented way of hysterectomy in the world; today we have a lot of techniques for hysterectomy. Total Laparoscopic Hysterectomy (TLH) versus Total Abdominal Hysterectomy (TAH) needs experience an assessment of the learning curve. Objective of the study was to determine the feasibility and safety of TLH and TAH.
Methods: Total 100 women were taken for study. Operating time, estimated blood loss, operating complication and length of stay in hospital were noted for each patient. The success rates of TLH were more compared to TAH. The operating time estimated blood loss, conversion to laparotomy was directly proportional to size of uterus.
Results: There were no statistically significant differences between the two groups regarding age, body mass index (BMI), specimen weight, pre-operative hemoglobin (Hb) value and rates of the complications. The mean post-operative Hb value was significantly higher in group TLH than group TAH (11.3±0.7 gr/dl versus 10.6±1.6, p = 0.03). The mean time of operation was significantly longer in TLH than group TAH (105.4±22.9 minutes versus 74±18, p<0.001). The mean duration of hospital stay was statistically shorter in TLH compared to the TAH (2.47±0.5 days versus 4.86±1.1, p<0.001).
Conclusions: Advantage of TLH over TAH are less blood loss, fewer wound infection and fever, smaller incisions, with less pain, shorter hospitalization time, speedier recovery.
Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy rates in the United States, 2003. Obstet Gynecol. 2007;110(5):1091-5.
Singh AJ, Arora AK. Effect of uterine prolapse on the lines of rural North Indian women. Singapore. J Obstet Gynecol. 2003;34:52-8.
Drahonovsky J, Haakova L, Otcenasek M, Krofta L, Kucera E, Feyereisl J. A prospective randomized comparison of vaginal hysterectomy laparoscopically assisted vaginal hysterectomy, and total laparoscopic hysterectomy in women with benign uterine disease. Eur J Obstet Gynecol Reprod Biol. 2010;148(2):172-6.
Clinch J. Length of hospital stay after vaginal hysterectomy. Br J Obstet Gynaecol. 1994;101(3):253-4.
Mccracken G, Hunter D, Morgan D, Price JH. Comparison of laparoscopic-assisted vaginal hysterectomy, total abdominal hysterectomy and vaginal hysterectomy. Ulster Med J. 2006;75(1):54-8.
Olsson JH, Ellstro¨m M, Hahlin M. A randomized prospective trial comparing laparoscopic and abdominal hysterectomy. Br J Obstet Gynaecol. 1996;103(4):345-50.
Howard FM, Sanchez R. A comparison of laparoscopic assisted vaginal hysterectomy and abdominal hysterectomy. J Gynecol Surg. 1993;9(2):83-90.
Nezhat F, Nezhat C, Gordons S, Wilkins F. Laparoscopic versus abdominal hysterectomy. J Reprod Med. 1992;37(3):247-50.
Perino A, Cucinella G, Venezia R, Castelli A, Cittadini E. Total laparoscopic hysterectomy versus total abdominal hysterectomy: an assessment of the learning curve in a prospective randomized study. Hum Reprod. 1999;14(12):2996-9.
Çelik C, Abali R, Tasdemir N, Aksu E, Çalışkan H, Akkuş D. Total Laparoskopik Histerektomi ve Abdominal Histerektomi Karşılaştırılması; Klinik Sonuçlar. JCAM. 2014;5(6):490-3.
Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009;8(3):CD003677.
Donnez O, Jadoul P, Squifflet J, Donnez J. A series of 3190 laparoscopic hysterectomies for benign disease from 1990 to 2006: evaluation of complications compared with vaginal and abdominal procedures. Int J Obst Gyn. 2009;116(4):492-500.
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.
Cho HY, Choi KJ, Lee YL, Chang KH, Kim HB, Park SH. Comparison of two bipolar systems in laparoscopic hysterectomy. J Society Laparoendo Surg. 2012;16(3):456-60.
Kluivers KB, Hendriks JC, Mol BW, Bongers MY, Bremer GL, Vet HC, et al. Quality of life and surgical outcome after total laparoscopic hysterectomy versus total abdominal hysterectomy for benign disease: a randomized, controlled trial. J Minim Invasive Gynecol. 2007;14(2):145-52.
Donnez O, Donnez J. A series of 400 laparoscopic hysterectomies for benign disease: a single centre, single surgeon prospective study of complications confirming previous retrospective study. Int J Obst Gyn. 2010;117(6):752-5.
Karaman Y, Bingol B, Gunenç Z. Prevention of complications in laparoscopic hysterectomy: experience with 1120 cases performed by a single surgeon. J Minim Invasive Gynecol. 2007;14(1):78-84.
Bojahr B, Raatz D, Schonleber G, Abri C, Ohlinger R. Perioperative complication rate in 1706 patients after a standardized laparoscopic supracervical hysterectomy technique. J Minim Invasive Gynecol. 2006;13(3):183-9.