Abstract
Purpose
To compare total laparoscopic hysterectomy (TLH), total abdominal hysterectomy (TAH) and vaginal hysterectomy (VH) using electrosurgical bipolar vessel sealing (EBVS) technique regarding operative time, intra and postoperative complications.
Methods
The current prospective randomized controlled clinical trial was conducted at Ain-shams University maternity Hospital, Cairo, Egypt. Ninety patients who were admitted from gynecologic outpatient clinic to undergo hysterectomy were enrolled. The study population was randomized according to type of hysterectomy done into 3 groups: group 1: VH; group 2: AH and group 3: TLH. EBVS was used in all groups. Three staff members’ surgeons were also randomized to operate on the patients and they were all equally competent in all the procedures. Main outcome measures were operative time, operative blood loss, operative complications, postoperative pain assessment using the visual analogue scale (0–10), and the need for analgesics as well as the postoperative hospital stay.
Results
Ninety patients were randomized to undergo VH, TAH or TLH for benign pathology using EBVS. Postoperative pain score and the need for analgesia were least in TLH compared to the other two groups, (p < 0.001). The hospital stay in TLH group was shorter than the other two groups, but there was no significant difference between VH group and TAH group with regard to hospital stay, (p < 0.001). The total operative time was shortest in the VH group (100.4 ± 35.8 min) compared to TLH (126 ± 42.7 min) and TAH (123.6 ± 44.5 min) (p = 0.033). The operative complications were more with VH and TAH groups. The blood loss was more with VH (p = 0.039).
Conclusion
TLH had a longer operation time, yet, less blood loss, shorter hospital stay, less postoperative pain and fewer complications, compared to TAH and VH using EBVS.
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Abbreviations
- AH:
-
Abdominal hysterectomy
- ANOVA:
-
One-way analysis of variance
- EBVS:
-
Electrosurgical bipolar vessel sealing
- LH:
-
Laparoscopic hysterectomy
- TLH:
-
Total laparoscopic hysterectomy
- VH:
-
Vaginal hysterectomy
- LAVH:
-
Laparoscopic-assisted vaginal hysterectomy
References
Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R et al (2009) Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 8(3):CD003677
Chapron C, Fauconnier A, Goffinet F, Bréart G, Dubuisson JB (2002) Laparoscopic surgery is not inherently dangerous for patients presenting with benign gynaecologic pathology. Results of a meta-analysis. Hum Reprod 17(5):1334–1342
Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R (2005) Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ 330(7506):1478
Elkington NM, Chou D (2006) A review of total laparoscopic hysterectomy: role, techniques and complications. Curr Opin Obstet Gynecol 18(4):380–384
Purohit RK (2003) Purohit technique of vaginal hysterectomy: a new approach. BJOG 110(12):1115–1119
Gendy R, Walsh CA, Walsh SR, Karantanis E (2011) Vaginal hysterectomy versus total laparoscopic hysterectomy for benign disease: a metaanalysis of randomized controlled trials. Am J Obstet Gynecol 204(5):388.e1–388.e8
Garry R, Fountain J, Brown J, Manca A, Mason S, Sculpher M et al (2004) EVALUATE hysterectomy trial: a multicentre randomised trial comparing abdominal, vaginal and laparoscopic methods of hysterectomy. Health Technol Assess 8(26):1–154
Kriplani A, Garg P, Sharma M, Lal S, Agarwal N (2008) A review of total laparoscopic hysterectomy using LigaSure uterine artery-sealing device: AIIMS experience. J Laparoendosc Adv Surg Tech A 18(6):825–829
Nieboer TE, Spaanderman ME, Bongers MY, Vierhout ME, Kluivers KB (2010) Gynecologists estimate and experience laparoscopic hysterectomy as more difficult compared with abdominal hysterectomy. Gynecol Surg 7(4):359–363
Silva-Filho AL, Werneck RA, de Magalhães RS, Belo AV, Triginelli SA (2006) Abdominal vs vaginal hysterectomy: a comparative study of the postoperative quality of life and satisfaction. Arch Gynecol Obstet 274(1):21–24
McCracken G, Hunter D, Morgan D, Price JH (2006) Comparison of laparoscopic-assisted vaginal hysterectomy, total abdominal hysterectomy and vaginal hysterectomy. Ulst Med J 75(1):54–58
Janssen PF, Brölmann HA, van Kesteren PJ, Bongers MY, Thurkow AL, Heymans MW et al (2011) Perioperative outcomes using LigaSure compared with conventional bipolar instruments in laparoscopic hysterectomy: a randomised controlled trial. BJOG 118(13):1568–1575
Zhu L, Lang JH, Liu CY, Shi HH, Sun ZJ, Fan R (2009) Clinical assessment for three routes of hysterectomy. Chin Med J (Engl) 122(4):377–380
Mäkinen J, Johansson J, Tomás C, Tomás E, Heinonen PK, Laatikainen T et al (2001) Morbidity of 10 110 hysterectomies by type of approach. Hum Reprod 16(7):1473–1478
Morelli M, Noia R, Chiodo D, Mocciaro R, Costantino A, Caruso MT et al (2007) Laparoscopic supracervical hysterectomy versus laparoscopic total hysterectomy: a prospective randomized study. Minerva Ginecol 59(1):1–10
Conflict of interest
The authors reported no conflict of interest. All of the authors had substantial contributions to conception and design, acquisition of data, analysis and interpretation of data, drafting and revising the article critically with final approval of the version to be published. The research was funded by the authors.
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Allam, I.S., Makled, A.K., Gomaa, I.A. et al. Total laparoscopic hysterectomy, vaginal hysterectomy and total abdominal hysterectomy using electrosurgical bipolar vessel sealing technique: a randomized controlled trial. Arch Gynecol Obstet 291, 1341–1345 (2015). https://doi.org/10.1007/s00404-014-3571-3
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DOI: https://doi.org/10.1007/s00404-014-3571-3