Feasibility of total laparoscopic hysterectomy as a day care procedure

Chitra, Thyagaraju; Modi, Rajesh

doi:10.5455/2320-1770.ijrcog20140982

Cited by 4 publications

(6 citation statements)

References 19 publications

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“…The implementation of the day case TLH protocol at our tertiary Queensland hospital has been successful and in line with previously published data demonstrating comparative patient safety 4,12 . Our same‐day discharge rate was 94.8% compared to similar studies showing same‐day discharge rates of 79.1%, 4 43% 5 and 67% 13 . These findings can provide invaluable incentive to perform day case TLHs especially in the current COVID pandemic where visitor policies are changing daily, and non‐emergent elective surgeries are cancelled due to lack of inpatient beds and need for emergency theatre access.…”

Section: Discussionsupporting

confidence: 87%

“…Previous research has shown that day case TLH demonstrates no compromise in patient care while increasing patient satisfaction when using skilled physicians, improved patient education and use of certain anaesthetic agents for improved recovery. [3][4][5] When assessing pre-operative factors contributing to the success of day case hysterectomies, surgeon experience, operating time and surgical technique were the most significant factors, with patient factors of younger age, lower body mass index and reduced co-morbidity score resulting in higher discharge rates. 6,7 Barriers to discharge identified in literature include pain, postoperative nausea and vomiting 8 and urinary retention, which were more likely with longer operating time, more blood loss and more intra-operative opioid use.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, TLH patients are suitable to be offered this as a day case procedure. Previous research has shown that day case TLH demonstrates no compromise in patient care while increasing patient satisfaction when using skilled physicians, improved patient education and use of certain anaesthetic agents for improved recovery 3–5 …”

Section: Introductionmentioning

confidence: 99%

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Introduction of the day case total laparoscopic hysterectomy (TLH) protocol

Byford

Madhok

Baldan

et al. 2022

Aust NZ J Obst Gynaeco

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Background Traditionally total laparoscopic hysterectomy (TLH) patients are admitted for 1–2 days post‐operatively. Day case TLH has been proven to be feasible and safe in other countries; however, this tertiary Queensland hospital is one of the first Australian institutions to introduce a day case TLH protocol. Aim To pilot the implementation of our day case TLH protocol assessing the feasibility, safety and patient satisfaction of same‐day discharge. Materials and Methods A retrospective audit of the implementation of our day case TLH protocol at a tertiary Queensland hospital was conducted. Primary outcome was length of post‐operative hospital stay. Secondary outcomes included perioperative complications and post‐operative re‐presentation rates. Patient satisfaction was assessed through a patient questionnaire. Results Seventy‐seven patients were included in the study. There were 94.81% patients who went home on the same day. Their average length of post‐operative hospital stay was 7.72 (SD ± 3.36) hours. Of the patients who did achieve same‐day discharge, the average length of stay was 7.05 (SD ±1.46) hours. There were no significant differences in perioperative complications or re‐presentation rates compared to previously published literature. Patients reported they were extremely satisfied with day case TLH. Conclusion The implementation of our day case TLH protocol is feasible, safe and well received by patients in our tertiary Australian hospital. These results can have multimodal effects in healthcare: decrease in hospital costs by reducing length of stay and overnight admissions, improved theatre efficiency and patient flow, while maintaining patient safety and satisfaction.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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Introduction of the day case total laparoscopic hysterectomy (TLH) protocol

Byford

Madhok

Baldan

et al. 2022

Aust NZ J Obst Gynaeco

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“…In recent years, the former abdominal hysterectomy has gradually been replaced by laparoscopy. Compared with traditional abdominal hysterectomy, laparoscopic hysterectomy has such advantages as shorter duration of operation, small trauma and rapid postoperative recovery and it can effectively diminish wound infection risks and does not cause as much pain to patients ( 11 , 12 ). In addition, laparoscopic hysterectomy can be used to inspect pelvic and abdominal organs by means of the laparoscope, directly showing the condition of fallopian tubes and ovaries and it can be used to diagnose accompanying diseases of the pelvic cavity such as endometriosis and it can separate abdominal and pelvic adhesions present ( 13 – 16 ).…”

Section: Discussionmentioning

confidence: 99%

Curative effect of laparoscopic hysterectomy for uterine fibroids and its impact on ovarian blood supply

Wang

Cheng

et al. 2017

Experimental and Therapeutic Medicine

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This study evaluates the curative effects laparo-scopic hysterectomies performed to treat uterine fibroids and determined the impact of the procedures on ovarian blood supply. A total of 124 patients with uterine fibroids admitted and treated in our hospital from December 2014 to December 2015 participated in the study. Two groups of 62 patients each were formed according to different operating plans; one group of patients underwent abdominal (open) panhysterectomy and were set as the control group; with the other group of patients were treated with laparoscopic hysterectomy and were set as the observation group. Ovarian endocrine function tests and blood supply changes were measured in both groups before the operation and one month after it, and the clinical conditions of all the patients were followed up for 24 months after surgery. Our results showed the duration of operation, amount of bleeding and time to recovery after the procedure were significantly lower in the patients in the observation group (P<0.05). Also, compared with preoperative conditions, the levels of PRL, FSH, E2, LH and other ovarian function markers in both groups were significantly lower one month after the operation, but the levels of the patients in the observation group were still significantly higher than those of the patients in the control group (P<0.05). Likewise, the surgeries affected the ovarian blood supply in patients of both groups, as evidenced by the lower levels of PI, RI, Vmin, Vmax and other blood supply indexes observed by Doppler ultrasound a month after the operations. However, the impact of the surgery on the ovarian blood supply was less marked in the patients in the observation group as their levels remained higher than those of patients in the control group (P<0.05). The numbers of patients with completely healed abdominal muscular layers in the observation group were always significantly higher than those of patients in the control group, at every different time point examined (1, 4, 8 and 12 months after surgery) (P<0.01). At the end of the 24 months of the follow-up period, the recurrence rate of fibroids for patients in the observation group was 4.8%. In our hands, the laparoscopic hysterectomy procedure to treat uterine fibroids showed the usual advantages over the abdominal open hysterectomy, like small trauma, short surgical procedure and rapid postoperative recovery, but it also proved to cause a significantly smaller impact on ovarian blood supply and should be considered whenever uterus preservation is a priority.

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“…The technique used for TLH was the Rajesh Modi technique with few modifications. 5 This technique has been used in our endoscopy unit since 2013. We used a uterine manipulator instead of myoma screw and a ligasure instead of standard bipolar grasper.…”

Section: Methodsmentioning

confidence: 99%

Vaginal Cuff Dehiscence After Total Laparoscopic Hysterectomy: Prospective Comparison of Two Types of Suturing Techniques

Dojki

Bano

Kanwal

2023

J Ayub Med Coll Abbottabad

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Background: To compare the frequency of vaginal cuff dehiscence after total laparoscopic hysterectomy between two different suturing techniques. Place and duration of study: The study was conducted at three centers; postgraduate tertiary care hospital, university affiliated hospital and private multidisciplinary hospital. The studied duration was from January 2019 to June 2020. Method: All patients with indication of total laparoscopic hysterectomy during the study period were included. These were randomly divided in to two groups A and B. Group A was performed upon the conventional interrupted figure of 8 vault suturing and group B with continuous, running, double layered suturing. Keeping the demographics almost same the frequency of a known but rare complication of vaginal cuff dehiscence (VCD) was determined. Results: A total of 195 patients were enrolled. Of these 87 were in group A and 108 in group B. The results were unequivocal as only one patient had the said complication. Conclusion: The morbid complication has no relation with the technique of vault suturing.

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Feasibility of total laparoscopic hysterectomy as a day care procedure

Cited by 4 publications

References 19 publications

Introduction of the day case total laparoscopic hysterectomy (TLH) protocol

Introduction of the day case total laparoscopic hysterectomy (TLH) protocol

Curative effect of laparoscopic hysterectomy for uterine fibroids and its impact on ovarian blood supply

Vaginal Cuff Dehiscence After Total Laparoscopic Hysterectomy: Prospective Comparison of Two Types of Suturing Techniques

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