Comparision of the pelviscopic hysterectomy techniques: CISH , TLH & LAVH

Park, P S; Tak, B M; Kim, K M; Kim, S T; Yang, K S; Chung, H S

Abstract

OBJECTIVE
Recently, pelviscopic hysterectomy is quite often tried. We mentioned here three techniques, that is, a classic intrafascial Semm hysterectomy(CISH), total pelviscopic hysterectomy(TLH), and laparoscopically assisted vaginal hysterectomy(LAVH), and compared the three techniques and the outcomes of each other through the clinical cases.
METHODS
We studied 138 pelviscopic hysterectomy cases, including 88 CISH, 35 TLH, and 15 LAVH cases, which were performed at Seoul Adventist Hospital from March 1994 to July l997. We compared the results each other with regard to the age, parity, operation time, blood loss, weight of uterus, past history of abdominal surgery, other additional operations, surgical indication, and, intra and post operative complications. As a statistic analysis, ANOVA and DMR were used for the study.
RESULTS
The mean operation time is affected by the surgens experiences and surgical instruments, but there was no significant difference on each operation time as following, 134.01 minutes for CISH, 129.23 minutes for TLH, and, 141.33 minutes for LAVH. The mean weight of uterus was 217.46 gm for CISH cases(the heavist among three), 188.23 gm for TLH, 190.40 gm for LAVH. The mean estimated blood loss of CISH was 178.74 cc, which was 36.67% less than that of TLH, 48.24% than that of LAVH. Especially in the cases of uterine myoma and adenomyosis, the estimated blood loss of CISH was 32.57% less than that of TLH, 50.78% than that of LAVH. As a surgical indication for all three techniques, uterine myoma was more comman indication than any other gynecological problem. The rate of intra and post operative complication of CISH was 15.9%, which was lower than 42.9% of TLH and 60.0% of LAVH, but, there was no fatal complication for all three. In the cases of CISH, complication of sexual function after operations was less compared to the other techniques, TLH and LAVH, because the pelvic floor support was maintained and less damaged,
CONCLUSION
Among the above three pelviscopic hysterectomy techniques, CISH was least of the mean estimated blood loss and complications and the most organ protective method in the case of the benign gynecological disease.