Total Laparoscopic Hysterectomy: A review of 300 cases

Gwon, Yong Il; Yoo, Young Ok; Lee, Hee Joong; Park, Tae Chul; Shin, Jin Woong; Lee, Joon Mo; Lee, Jin Woo; Namgoong, Sung Eun

Abstract

OBJECTIVE
We analyzed our experience with total laparoscopic hysterectomy to evaluate the clinical data such as operation time, blood loss, hospital stay, and complications.
METHODS
A retrospective study was carried out in 300 women who underwent total laparoscopic hysterectomy (TLH).
RESULTS
The most common indications for TLH were uterine myomas, chronic pelvic pain (severe endometriosis), cervical intraepithelial neoplasia. Mean operating time was 90 minutes (range 50-200 min) and hospital stay was 3 days (range 2 days-7 days). The most important factors for the surgery time were uterine size, assistant's skill, presence of adhesions (obliteration of the cul-de-sac due to severe endometriosis). Several techniques were used, including bipolar coagulation of the uterine vessels, and suture of the stump. A special uterine manipulator (RUMITM uterine manipulator with colpotomizer and pneumooccluder balloon) used in all procedures aided in anatomic definition and performing the circumferential colpotomy. We had three bladder injuries during operation which was diagnosed and immediately repaired laparoscopically. We had two cases of ureterovaginal fistula and one case of postoperative ileus. But there were no cases of death, thrombophlebitis neither other pulmonary complications.
CONCLUSIONS
Total laparoscopic hysterectomy can be performed safely and effectively when the surgical team is sufficiently trained. And we believe that total laparoscopic hysterectomy offers benefits to the patients in the form of less post-operative pain, shorter time in hospital.