Korean J Obstet Gynecol.  2011 Oct;54(10):618-622. 10.5468/KJOG.2011.54.10.618.

Clinical outcomes of 1,041 total laparoscopic hysterectomies: Six years of experience in a single center

Affiliations
  • 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

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.

Keyword

Hysterectomy; Outcome assessment

MeSH Terms

Adenomyosis
Cystectomy
Endometrial Neoplasms
Female
Hemoglobins
Humans
Hysterectomy
Laparotomy
Leiomyoma
Length of Stay
Lymph Node Excision
Medical Records
Ovarian Neoplasms
Sarcoma
Ureter
Uterine Cervical Neoplasms
Hemoglobins

Figure

  • Fig. 1 Relationship between uterus size and laparotomy conversion. AUC, area under the curve. aChi-squared test.

  • Fig. 2 Relationship between uterus size and operation time. P < 0.01 (one-way analysis of variance).


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