Archives of Gynecology and Obstetrics

, Volume 288, Issue 6, pp 1329–1339

Laparoscopic supracervical hysterectomy (LSH) versus total laparoscopic hysterectomy (TLH): an implementation study in 1,952 patients with an analysis of risk factors for conversion to laparotomy and complications, and of procedure-specific re-operations

  • Markus Wallwiener
  • Florin-Andrei Taran
  • Ralf Rothmund
  • Adam Kasperkowiak
  • Gabriel Auwärter
  • Antje Ganz
  • Bernhard Kraemer
  • Harald Abele
  • Birgitt Schönfisch
  • Keith B. Isaacson
  • Sara Yvonne Brucker
General Gynecology

DOI: 10.1007/s00404-013-2921-x

Cite this article as:
Wallwiener, M., Taran, FA., Rothmund, R. et al. Arch Gynecol Obstet (2013) 288: 1329. doi:10.1007/s00404-013-2921-x

Abstract

Purpose

To compare laparoscopic supracervical hysterectomy (LSH) with total laparoscopic hysterectomy (TLH) with regard to relevant surgical parameters and risk factors of conversion to laparotomy and complications.

Methods

This prospective, open, single-center, interventional study included women with benign gynecologic disease who underwent standardized LSH or TLH. The techniques were compared for conversion rate and mean operating time, hemoglobin drop, hospital stay, and complication rates using descriptive statistics and standard non-parametric statistical tests. Risk factors of conversion and complications were identified by logistic regression analysis.

Results

During January 2003 to December 2010, 1,952 women [mean age (SD): 47.5 (7.2) years] underwent LSH [1,658 (84.9 %)] or TLH [294 (15.1 %)], mostly (>70 %) for uterine fibroids. Significant differences in surgical parameters were observed for conversion rate (LSH/TLH: 2.6/6.5 %), mean operating time [87 (34)/103 (36) min], hemoglobin drop [1.3 (0.8)/1.6 (1.0) g/dL], and hospital stay [4.3 (1.5)/4.9 (2.8) days]. Overall intraoperative (0.2/0.7 %) and long-term (>6 weeks) post-operative (0.8/1.7 %) complication rates did not differ significantly, but the short-term LSH complication rate was significantly lower (0.6 vs. 4.8 %). Spotting (LSH, 0.2 %) and vaginal cuff dehiscence (TLH, 0.7 %) were long-term method-specific complications. Logistic regression showed that uterine weight and extensive adhesiolysis were significant factors for conversion while previous surgery, age, and BMI were not. Major risk factors of short-term complications were age, procedure (LSH/TLH), and extensive adhesions.

Conclusions

Both procedures proved effective and were well tolerated. LSH performed better than TLH regarding most outcome measures. LSH is associated with very low rates of re-operation and spotting.

Keywords

HysterectomyLaparoscopyLASHBenign gynecologic diseaseComparison of surgical techniquesPrediction of complications

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Markus Wallwiener
    • 1
  • Florin-Andrei Taran
    • 2
  • Ralf Rothmund
    • 2
  • Adam Kasperkowiak
    • 2
  • Gabriel Auwärter
    • 2
  • Antje Ganz
    • 2
  • Bernhard Kraemer
    • 2
  • Harald Abele
    • 2
  • Birgitt Schönfisch
    • 2
  • Keith B. Isaacson
    • 3
  • Sara Yvonne Brucker
    • 2
  1. 1.Department of Obstetrics and GynecologyUniversity of HeidelbergHeidelbergGermany
  2. 2.Department of Obstetrics and GynecologyUniversity of TübingenTübingenGermany
  3. 3.Center for Minimally Invasive Gynecologic SurgeryNewton-Wellesley HospitalNewtonUSA