The clinical studies on 600 cases of total laparoscopic hysterectomy (TLH)

Kim, Sheenae; Son, Hyaeyeon; Park, Sungho; Chung, Ji Youn; Kim, Hongbae; Lee, Yongwoo; Jang, Pongrheem; Kwon, Yongil

Abstract

OBJECTIVE
To analyze the clinical characteristics of total laparoscopic hysterectomy.
METHODS
Clinical data about 600 cases who received TLH were collected and the hospital stay, operation time and complication were evaluated.
RESULTS
The most common indications for TLH were uterine myomas, adenomyosis, severe endometriosis and cervical intraepithelial neoplasia. Mean operating time was 90 minutes (range 35-200 min) and hospital stay was 3 days (range 2 days-10 days). The most important factors for the surgery time were uterine size, assistant's skill and presence of adhesions (obliteration of the cul-de-sac due to severe pelvic endometriosis). Several techniques were used, including bipolar coagulation of the ovarian and 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 two cases of ureteral obliteration by using bipolar coagulator, and 3 cases of bladder injuries during operation which was diagnosed and immediately repaired laparoscopically. We had two cases of ureterovaginal fistula, two cases of postoperative ileus and one case of bowel perforation. But there were no cases of death, thrombophlebitis or 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.