| Clinical outcomes of 1,041 total laparoscopic hysterectomies: Six years of experience in a single center. |
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Jeong Min Moon, Jae Hong No, Yong Tark Jeon, Byung Chul Jee, Yong Beom Kim |
1Department of Obstetrics and Gynecology, Bundang Jesaeng General Hospital, Seongnam, Korea.
2Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea. ybkimlh@snubh.org |
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| Abstract |
OBJECTIVE
To evaluate the association between outcomes of total laparoscopic hysterectomy (TLH) and patient demographic and clinical factors. METHODS: The present study was performed on a total of 1,041 women who underwent TLH, with or without bilateral/unilateral salpingo-oophorectomy, from May 2003 to December 2008, excluding patients who also underwent other procedures simultaneously, including ovarian cystectomy, colporrhaphy, incontinence surgery, pelvic/para-aortic lymph node dissection, and/or omentectomy. The medical records were reviewed and clinical outcomes were analyzed. RESULTS: Mean patient age was 46.6 +/- 13.4 years, mean operation time was 103.4 +/- 42.3 minutes, and mean duration of total hospital stay was 5.4 +/- 2.9 days. The mean decrease in hemoglobin concentration from before operation to 1 day after surgery was 1.4 +/- 0.9 g/dL, and one patient required an intraoperative transfusion. The main diagnosis was leiomyoma including concomitant adenomyosis (62.2%), followed by adenomyosis (16.0%) and 32 early stage gynecologic malignancies including 20 patients with microinvasive cervical cancer, 10 with endometrial cancer, 1 with borderline ovarian cancer, and 1 with uterine sarcoma. Laparotomy conversion was occurred in 45 patients (4.2%), because of severe pelvic/abdominal adhesion or huge uterine size. Large uterine size was associated with a significantly higher rate of conversion (7.9% vs. 2.6%, P < 0.01), and a significantly longer operation time (110.5 minutes vs. 93.1 minutes vs. 95.3 minutes, P < 0.01). Overall, 6 patients (0.6%) experienced major complications, including two bowel perforations, two ureteral injuries requiring surgical repair, one vaginal evisceration, and one incisional hernia. CONCLUSION: TLH is a safe and acceptable alternative to standard hysterectomy for various indications, including malignancy. |
| Key Words:
Hysterectomy, Outcome assessment |
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