COMPARATIVE STUDY BETWEEN DIFFERENT METHODS OF LAPAROSCOPIC HYSTERECTOMIES

Abstract

Background: Hysterectomy is the most common of all gynaecological operations. Until the
late 1980, there were two available approaches for hysterectomy: abdominal or vaginal, then
laparoscopy developed. Objectives: To compare the clinical results of three minimally
invasive laparoscopic hysterectomy techniques: Laparoscopic Assisted Supracervical
Hysterectomy(LASH) (Laparoscopic Assisted Vaignal Hysterectomy (LAVH) and Total
Laparoscopic Hysterectomy (TLH). Patients and methods: A prospective, randomized study
was performed at Cytogenetic and Endoscopic Unit, Obstetrics and Gynecology Department,
Faculty of Medicine, Zagazig University Hospitals between March 2007 and May 2010. A
total of 60 women indicated to undergo hysterectomy for benign uterine disease were
randomly assigned to three different groups (20 LASH, 20 LAVH and 20 TLH). Outcome
measures, including operating time, blood loss, rate of complications, consumption of
analgesics and length of hospital stay were assessed and compared between groups. Results:
Laparoscopic assisted supracervical hysterectomy had the shortest operating time (84.4 ± 13.1
minutes) and smallest drop in hemoglobin. Also, no operative or postoperative complications
occurred in this group and took the least analgesic dose. Laparoscopic assisted vaginal
hysterectomy had the longest operating time (104.1 ± 10.4 minutes) and this may be due to
changing patient position from Trendelenburg to lithotomy and doing under water
examination at the end of the procedure, but LAVH showed acceptable drop in hemoglobin,
complications, and need to analgesia and hospital stay. Total laparoscopic hysterectomy had
acceptable operating time but largest drop in hemoglobin. Also, urinary complications in the
form of bladder injury occurred in this group. Also, this group took more analgesia and more
hospital stay, but there was no statistically difference between the last 2 groups in
complication rate, hemoglobin deficit, and need to analgesia. Conclusion: Based on our
results, in women with non-malignant diseases of the uterus, LASH seems to be the preferred
laparoscopic hysterectomy technique for gynaecological surgeons, but follow up of the
cervical changes must be done annually either by colposcopy or by pap smear, but if the
patients need to remove the cervix for difficulty in follow up or for fear of malignancy, both
other types of laparoscopic hysterectomy must be offered for her and if we exclude the only
one complicated case in TLH group, there will be no statistically difference between TLH and
LAVH.