A series of 3190 laparoscopic hysterectomies for benign disease from 1990 to 2006: evaluation of complications compared with vaginal and abdominal procedures

TLDR

Since the early 1990s, laparoscopic hysterectomy has steadily increased in frequency while vaginal and abdominal hysterectomies have declined. This study aimed to evaluate the complication rates of laparoscopic total and subtotal hysterectomies performed for benign disease. Among 4,505 hysterectomies performed by a single team from 1990 to 2006, 3,190 were laparoscopic, 906 vaginal, and 409 abdominal, with all complications recorded prospectively and later analyzed retrospectively. Minor and major complication rates were 0.99%/0.37% for LASH, 1.14%/0.51% for TLH, 0.77%/0.33% for vaginal, and 0.73%/0.49% for abdominal hysterectomies, indicating that laparoscopic procedures did not increase major complications in experienced hands.

Abstract

The aim of this study was to evaluate the complication rate after laparoscopic total hysterectomy and laparoscopic subtotal hysterectomy (LASH) in case of benign disease.All complications were prospectively recorded at the time of surgery and analysed retrospectively.University hospital.Among 4505 hysterectomies performed by the same team using the same techniques between 1990 and 2006, 3190 were performed by laparoscopy, 906 by the vaginal route and 409 by laparotomy.Laparoscopic hysterectomies, defined as laparoscopic subtotal hysterectomy (LASH) and total laparoscopic hysterectomy [laparoscopy-assisted vaginal hysterectomy (LAVH) switched to total laparoscopic hysterectomy (TLH) in 2000], were compared with vaginal and abdominal hysterectomies.Since the early 1990s, the number of laparoscopic procedures has continued to grow, while the number of abdominal and vaginal procedures has decreased. Both minor complications (fever >38.5 degrees C after 2 days, bladder incision of <2 cm and iatrogenic adenomyosis) and major complications (haemorrhage, vesicoperitoneal fistula, ureteral injury, rectal perforation or fistula) have been observed during the surgical procedure itself and postoperatively. In the LASH group (n = 1613), the minor complication rate was 0.99% (n = 16) and the major complication rate 0.37% (n = 6). In the total laparoscopic hysterectomy (LAVH/TLH) group (n = 1577), the minor complication rate was 1.14% (n = 18) and the major complication rate 0.51% (n = 8). In the vaginal hysterectomy group (n = 906), minor and major complication rates were 0.77% (n = 7) and 0.33% (n = 3), respectively. In the abdominal hysterectomy group (n = 409), minor and major complication rates were 0.73% (n = 3) and 0.49% (n = 2), respectively.The results from our series of 4505 women clearly show that, in experienced hands, laparoscopic hysterectomy is not associated with any increase in major complication rates.