Archives of Gynecology and Obstetrics

, Volume 288, Issue 6, pp 1329–1339 | Cite as

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

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

Hysterectomy Laparoscopy LASH Benign gynecologic disease Comparison of surgical techniques Prediction of complications 

Notes

Acknowledgments

The authors thank Sandra Ebersoll, Christian W. Wallwiener, and Adam Kasperkowiak for excellent technical assistance. No financial support or funding was received for this study.

Conflict of interest

All authors were employees of their respective university hospital. SYB was actively involved in the development of the SupraLoop™ unipolar loop for LSH. None of the authors have any financial relationships with instrument or equipment manufacturers or other commercial interests that might represent potential conflicts of interest regarding this work.

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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

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