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Total laparoscopic hysterectomy versus total abdominal hysterectomy in the treatment of benign gynaecological disease: a retrospective review over 5 years

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Gynecological Surgery

Abstract

Hysterectomy remains one of the most common gynaecological procedures performed in the UK. However, unlike other parts of Europe and America, where laparoscopic hysterectomy (LH) rates have significantly increased, in the UK, abdominal hysterectomy (AH) rates remain high and often the first choice for many surgeons. The minimal access route offers significant patient benefits over open surgery, and the purpose of this study was to evaluate the role of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) in the management of benign gynaecological conditions. This retrospective study was carried out over a 5-year period, and 296 procedures were included. Outcome measures included operating time, estimated blood loss (EBL), intraoperative and postoperative complications, postoperative analgesia requirements and length of hospital stay. TLH was associated with a significantly lower mean operating time (63.4 versus 75.3 min, P = <0.001) and reduced EBL (145.1 versus 277.0 ml, P = <0.001). Intraoperative complications were significantly less in the TLH group (1.9 versus 7.0 %, P = 0.029) with no ureteric injuries noted. Postoperative complications were also lower (6.8 versus 15.6 %, P = 0.016). TLH was also associated with significantly less analgesia requirements, with fewer requiring breakthrough analgesia (6.2 versus 26.6 %, P = <0.001), and a significantly shorter inpatient hospital stay (1.7 versus 3.0 days, P = <0.001). The results from our study highlight that TLH is superior to TAH in all operative outcome measures. With adequate training and experience, TLH is a safe, reproducible technique that should be offered to all women requiring a hysterectomy for a normal sized uterus in the absence of significant adhesions.

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Authorsʼ contribution

R Mallick: Project development, data collection and analysis, manuscript writing.

J English: Project development, manuscript writing.

N Waters: Project development, manuscript writing.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Brighton and Sussex University Hospitals, Royal Sussex County Hospital, Eastern Road, Brighton, East Sussex, BN2 5BE, UK

    Rebecca Mallick & James English

  2. Western Sussex Hospitals NHS Trust, Worthing, UK

    Natasha Waters

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  1. Rebecca Mallick
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  2. James English
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  3. Natasha Waters
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Correspondence to Rebecca Mallick.

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No funding was provided for this research.

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All authors declare no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Mallick, R., English, J. & Waters, N. Total laparoscopic hysterectomy versus total abdominal hysterectomy in the treatment of benign gynaecological disease: a retrospective review over 5 years. Gynecol Surg 13, 359–364 (2016). https://doi.org/10.1007/s10397-016-0990-0

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  • DOI: https://doi.org/10.1007/s10397-016-0990-0

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