The Hohl instrument for optimizing total laparoscopic hysterectomy: results of more than 500 procedures in a university training center (original) (raw)
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Gynecological Surgery, 2020
Objective To compare laparoscopic hysterectomy (LH) with total abdominal hysterectomy (TAH) regarding different outcome measures at our tertiary hospital. Study design This retrospective comparative cross-sectional study was conducted at the Department of Obstetrics and Gynecology Department, Women’s Hospital, Hamad Medical Corporation, Doha, Qatar. It included 44 patients who had LH (group 1) and 95 patients who had TAH (group 2) during the period from January 2009 through June 2014. Results Three patients were converted from LH to TAH and were excluded from the final analysis. The size of the uterus was smaller in the LH group than the TAH group (7.38 ± 1.92 vs 10.25 ± 3.84 cm, respectively; p < 0.0005). The operative time was shorter in TAH than in LH (2.22 ± 0.93 vs 2.43 ± 0.94, respectively; p = NS). The blood loss was less in the LH group than the TAH group (258.54 ± 65.26 vs 370.32 ± 74.8, respectively; p = NS). There were no significant differences between both groups reg...
Trends and patterns in total laparoscopic hysterectomy in tertiary care hospital
Background: Due to technical advances in the field of laparoscopy, there has been an increase in total laparoscopic hysterectomies all over the world in last decade. This study was conducted to analyse the technique and surgical outcome of total laparoscopic hysterectomy in tertiary care hospital Methods: This is a retrospective cohort (observational) study, which included all patients who underwent Total Laparoscopic Hysterectomy (TLH) for benign conditions from January 2012 to December 2017 at the tertiary Care Hospital. The data so obtained was analysed for various parameters like indication for surgery, mean operating time, length of hospital stay, complications and conversion to abdominal route. Results: Total number of 2307 hysterectomies were performed over a period of 5 years. Of these, TLH were 270 (11.70%). Amongst those undergoing TLH, the mean age was 45±7.84 years. The most common indication for the surgery was fibroid uterus (38.14%), followed by dysfunctional uterine bleeding (28.88%), and adenomyosis (15.1%). The mean estimated blood loss was 106±4.34 ml. Hemorrhage (n = 2) and bladder injury (n = 4) were most common surgical complications. Conclusions: TLH is safe and effective procedure for most of the benign pelvic conditions. With adequate training TLH can be used more widely in tertiary care hospital and teaching institute. Keywords: Abdominal hysterectomy, TLH, Vaginal hysterectomy
Comparative Study between Different Methods of Laparoscopic Hysterectomies
Journal of Obstetrics Gynecology and Reproductive Sciences
Background: Hysterectomy is the second most common major surgical procedure performed on women after caesarean section. The incidence of hysterectomy is 4-6% out of which 90% are performed for benign indications. Aim of the work: The aim of this study was to compare intra- and post-operative morbidity associated with two types of laparoscopic hysterectomy. Laparoscopic-Assisted Vaginal Hysterectomy (LAVH) and Total Laparoscopic Hysterectomy (TLH) Patients and methods: A total of 80 women scheduled to undergo a hysterectomy for benign disease were subdivided into 2 groups; 40 women for LAVH and 40 women for TLH, Patients were excluded from the study if they had contraindication to laparoscopy. Intra- and post-operative evaluations including the duration of the operation uterine weight, frequency of intraoperative complication, and the difference between hemoglobin level prior to surgery and one day after surgery. Results: LAVH took the longest operating time. As regard hemoglobin def...
Analysis of Total Laparoscopic Hysterectomy Operations Performed in Our Clinic
Objective: The purpose of this study was to evaluate the results of our experience with 83 patients who underwent total laparoscopic hysterectomy (TLH). Methods: The subjects included 83 patients operated in Gaziosmanpaşa Taksim Training and Research Hospital, Department of Obstetrics and Gynecology. Total laparoscopic hysterectomies were performed for various indications between January 2013 and October 2014. Indications of total laparoscopic hysterectomy, method of operation, intraoperative and postoperative complications, duration of the operation, length of hospital stay, and blood loss in patients who underwent total laparoscopic hysterectomies were retrospectively evaluated. Results: In total, 83 patients were included in our study. The mean age was 49.3 years. The most common indication for total laparoscopic hysterectomy was menorrhagia. The mean body mass index (BMI) was 28.7±4.3. The mean operation time was 132.16±48.5 min, mean hospital stay was 3.38±1.6 days, and mean blood loss was 2 g/dL. The overall complication rate was 6%. Conclusion: Total laparoscopic hysterectomy is a preferred method to abdominal hysterectomy because it is associated with a more favorable surgical outcome. The laparoscopic approach is an acceptable treatment modality in the current gynecological practice. Total laparoscopic hysterectomy is more beneficial to patients because of low estimated blood loss, less analgesia use, low intraoperative and postoperative complication rates, less postoperative pain, more rapid recovery, and short hospital stays. However, the percentage of total laparoscopic hysterectomies is still very low. The longer operation time in total laparoscopic hysterectomy, an unfavorable learning curve, and extensive training of surgeons and the whole surgical team are often cited as reasons.
Analysis of Total Laparoscopic Hysterectomy Performed in Our Clinic
Journal of Academic Research in Medicine, 2015
Objective: The purpose of this study was to evaluate the results of our experience with 83 patients who underwent total laparoscopic hysterectomy (TLH). Methods: The subjects included 83 patients operated in Gaziosmanpaşa Taksim Training and Research Hospital, Department of Obstetrics and Gynecology. Total laparoscopic hysterectomies were performed for various indications between January 2013 and October 2014. Indications of total laparoscopic hysterectomy, method of operation, intraoperative and postoperative complications, duration of the operation, length of hospital stay, and blood loss in patients who underwent total laparoscopic hysterectomies were retrospectively evaluated. Results: In total, 83 patients were included in our study. The mean age was 49.3 years. The most common indication for total laparoscopic hysterectomy was menorrhagia. The mean body mass index (BMI) was 28.7±4.3. The mean operation time was 132.16±48.5 min, mean hospital stay was 3.38±1.6 days, and mean blood loss was 2 g/dL. The overall complication rate was 6%. Conclusion: Total laparoscopic hysterectomy is a preferred method to abdominal hysterectomy because it is associated with a more favorable surgical outcome. The laparoscopic approach is an acceptable treatment modality in the current gynecological practice. Total laparoscopic hysterectomy is more beneficial to patients because of low estimated blood loss, less analgesia use, low intraoperative and postoperative complication rates, less postoperative pain, more rapid recovery, and short hospital stays. However, the percentage of total laparoscopic hysterectomies is still very low. The longer operation time in total laparoscopic hysterectomy, an unfavorable learning curve, and extensive training of surgeons and the whole surgical team are often cited as reasons.
Total Laparoscopic Hysterectomy: Technique and Complications of 830 Cases
JSLS : Journal of the Society of Laparoendoscopic Surgeons, 2007
Objective: This study analyses the technique and complications from total laparoscopic hysterectomy. Methods: Retrospective chart abstraction was performed on 830 consecutive patients operated on between 1996 and 2006. Demographic and surgical data were analyzed by ANOVA, chi-square, and Spearman and Pearson correlation techniques were used with significance set at P<0.05. Results: Of 830 consecutive patients, 5 (0.6%) were converted to laparotomy. Patients had a mean age of 50 (±11) years, a mean of 1.3 (±1.3) pregnancies, and a mean BMI of 27.6 (±6.8) kg/m2. The mean surgical duration was 132 (±55) minutes, with mean blood loss of 130 (±189) mL and average hospital stay of 1.4 (±0.9) days. Duration of surgery, blood loss, and hospital stay all decreased with the surgeon's increasing experience. Reoperative complications occurred in 38 patients (4.7%). Urologic injuries were observed in 23 patients (2.6%), with 9 (1.1%) requiring reoperation. Conclusions: This technique for ...
Comparison of total laparoscopic, vaginal and abdominal hysterectomy
Archives of Gynecology and Obstetrics, 2008
Introduction Due to technical improvements and growing experience, hysterectomies are performed laparoscopically more and more frequently. We analyzed 43 total laparoscopic hysterectomies (TLH) of the years 2005 and 2006 and compared them with 87 vaginal (VH) and 103 abdominal hysterectomies (AH). Methods Patients' original Wles and surgery reports of the TLHs, VHs and AHs were analyzed retrospectively for the indication of surgery, patients' age, weight, parity, time for surgery, uterus weight, blood loss, post-operative need of analgetics, hospital stay, complications and so on. Data were compared with Student's t test and 2 test. Results Indications for TLH were Wbroids (n = 21), endometrial cancer (n = 10), bleeding anomalies (n = 7), dysplasia of the cervix uteri (n = 3) and others. In 23/43 cases salpingo-ovarectomy was added, in six cases laparoscopic pelvic or paraaortic lymphadenectomy (LNE) was performed. Looking at cases without LNE, patients' median age was 46 years (32-72), median weight 68 kg (53-115), median time for TLH 130 min (75-270), median uterus weight 150 g (44-954), median blood loss 200 ml (50-600), postoperative analgetica were given for 1.5 days (0-12), and post-operative hospital stay was 6 days (2-15). Indications for VH were genital prolapse (n = 53, 61%), often combined with Wxative procedures (n = 50). In this group, median age was signiWcantly higher (median 56 years, P < 0.001). VH was the fastest (median 90 min, P < 0.001), but blood loss was highest (median 300 ml, P = 0.07). In cases with AH, uterus weight was signiWcantly higher (median 290 g, P < 0.001), as well as the need for analgetics (median 4 days, P = 0.001), and the hospital stay was longest (median 8 days, P < 0.001). Major complications of TLH were bladder injury (3£), of VH rectum lesion (2£, both at pelvic repair measures), of AH post-operative ileus (2£) and vesico-vaginal Wstula (1£). Conclusion For many patients TLH is a safe and less invasive alternative, especially towards AH, and shows sig-niWcantly better post-operative reconstitution. Although VH is faster and shows comparable post-operative results, TLH oVers the advantage to view the intra-abdominal situs and perform additional steps in case of pathologies.
A comparative study of laparoscopic and abdominal hysterectomies
Serbian Journal of Experimental and Clinical Research, 2008
This case study shows comparative results of laparoscopic and abdominal hysterectomies. It includes 503 hysterectomies in connection to myomas of the uterus, performed in the period between January 2000 and December 2006. There were 64 (12.75%) patients that underwent laparoscopic hysterectomy (LH) and 439 (87.28%) patients subjected to abdominal hysterectomy (AH). The average age of patients subjected to LH was 48.91 years; for those in the AH group, average age was 46.47 years (P<0.01). Statistically speaking, there was a considerable difference between AH and LH in the number of myomas (2.06 vs.2.90), volume (281.0373 cm 3 vs. 476.9426 cm 3 ) and weight of the uterus (236.25 grams vs. 431.53 grams). The average duration of surgical procedures for LH was 98.8 minutes, while the AH procedures lasted for an average of 67.52 minutes (p<0.01). The main advantages of laparoscopic interventions include minor deterioration in the quality of blood test results and fewer patients dem...
Total laparoscopic hysterectomy: a 5-year experience
Archives of Gynecology and Obstetrics, 2007
Aim To evaluate our surgical technique with regards to the success of total laparoscopic hysterectomy (TLH) for the removal of the uterus by analysing its intra-operative and post-operative outcomes and complications in the hope of reducing their occurrence. Methods Retrospective study based on TLH operations performed from January 2001 to December 2005. The KOH Colpotomizer™ System and the RUMI Uterine Manipulator ® were used. Results Five hundred and twelve women consented for TLH. Five hundred and three women (98.2%) had successful TLH with three mini-laparotomy and six laparotomy conversions (1.8% failure rate). Mean uterine size was 11 cm (5-17). Mean operating time was 133 min (40-257). Mean blood loss was 309 ml (50-1,500). Twenty patients (4%) required blood transfusion (Wve excessive bleeding). Injuries include bowel injury (5), bladder (2), uterine perforation (1), ureterovaginal Wstula (1) and vaginal laceration (5). Post-operative complications include pyrexia (36), umbilical wound infection (5), urinary tract infection (UTI) (4) and vault haematoma (3). Mean hospital stay was 2.7 days (1-10). Eighteen patients (3.6%) were readmitted for vaginal bleeding (10), vault haematoma (2), UTI (1), anxiety (3), giddiness (1) and ureterovaginal Wstula (1). Twenty-three women (4.5%) encountered major complications (laparotomy conversion, excessive bleeding requiring blood transfusion, hemorrhage ¸1,000 ml, ureteric injury, bowel injury and pulmonary embolus) which compares favourably with other centres (4-11%). Our mean operating time, mean estimated blood loss, mean hospital stay and readmission rate are comparable. Conclusion TLH with adequate training is associated with low morbidity, few complications and a high success rate.