A comparative study between Total Laparoscopic Hysterectomy (TLH) and conventional Total Abdominal Hysterectomy (TAH) in non-neoplastic uterine diseases

Abstract

Introduction: In the past decade, laparoscopic route of surgery has been on an increase especially for nonneoplastic uterine diseases. The present study aims to study and compare between Total Laparoscopic Hysterectomy (TLH) and conventional TAH (Total Abdominal Hysterectomy) in terms of characteristics like blood loss, operative time, intraoperative complications, postoperative pain & mobilisation, analgesic requirements, duration of hospital stay and finally patient satisfaction. Materials and methods: In this randomized prospective comparative study, 100 consecutive patients of hysterectomy (50 each of total TAH and TLH) at a tertiary care center in western India, were recruited. The present study aims to study and compare between TLH and conventional TAH (Total Abdominal Hysterectomy), in non-neoplastic uterine diseases, in terms of characteristics like blood loss, operative time, intraoperative complications, postoperative pain & mobilisation, analgesic requirements, duration of hospital stay and finally patient satisfaction. Results: We observed that average blood loss, postoperative pain and analgesic requirement and mean length of hospital stay in TLH was lesser than TAH group (p< 0.001). An average time taken for TLH as well as patient satisfaction level was more (p< 0.001) than that in TAH group. Intraoperative complications were comparable and not significantly different among the two procedures. Mobilization after the procedure was quicker in laparoscopic hysterectomy. Mobilization of patients during postoperative period was significantly earlier (p< 0.0001) in TLH group (12.2 hours) while in TAH (22.3 hours. Patient satisfaction level was 90% in patients in TLH group while only 60% for patients in TAH group. Conclusion: TLH is a safe and effective method of doing hysterectomy and it is a good alternative of conventional abdominal hysterectomy, especially after good training to standardized the procedure, proper case selection, day to day practice of the technique and application of sound surgical principles.

A Comparison between Total Abdominal Hysterectomy versus Total Laparoscopic Hysterectomy

“…A large uterus can be removed through the vagina, and hand morcellation is sometimes required. The average uterine size was reported to be smaller in TLH than in TAH;[ 1 3 5 ] however, this was not significant in our study.…”

“…Intraoperative blood loss volume and inhospital stay duration were lower in the TLH than in the TAH group. [ 1 3 5 6 7 8 9 10 11 12 13 14 15 ] In our study, blood loss volume was lower in the TLH group than in the TAH group by an average of 150 mL, possibly due to blood loss during skin incision and the use of traditional hemostasis (clamping and tying) compared to advanced bipolar energy used in TLH. Similarly, other studies have related this effect to the magnified visual field and the use of bipolar diathermy.…”

“…In addition, urinary tract injuries during laparoscopy were not observed in their 50 TLH cases. [ 3 ] A retrospective study from the Department of Obstetrics and Gynecology, Women’s Hospital, Hamad Medical Corporation, Doha, Qatar, showed that inhospital stay was shorter in TLH than in TAH. Late postoperative complications, such as wound gaping, were significantly fewer in TLH than in TAH patients, without a significant between-group difference in EBL.…”

A comparative study between total laparoscopic hysterectomy and total abdominal hysterectomy for benign uterine pathologies at tertiary care institute, Udaipur

“…In current study patient satisfaction was found highly significant between TLH and TAH (100% versus 56%, p<0.001) similar result was showed by Gupta et al 23 The reason for better postoperative comfort in TLH was that it required only a small skin incision, thereby resulting in reduced postoperative pain and minimal blood loss. Consequently, patients can quickly resume the activities of daily living and TLH could contribute to patients' quality of life as also observed by Komatsu et al 30 Postoperative follow up of patients 4 weeks after discharge showed better quality of life, lesser morbidity and higher satisfaction rate in TLH group.…”

“…Similar results were reported by Gupta et al in their comparative study between TLH and conventional TAH in non-neoplastic uterine diseases. 23 In present study the comparison regarding postoperative day of catheter removal was significant between TLH and TAH groups (2.00±0.00 versus 3.96±2.92; p=0.002). In TLH group catheter was removed on second postoperative day in all patients, but in TAH group in 88% ( 22) of patient's catheter were removed on third day, but in 4% (1) patient on 5th day and in 4% (1) patient in 7th day because bladder adherent to lower uterine segment and in 4% (1) patient on 21st day because there was bladder injury happened.…”