Keyhole to no hole hysterectomy - A retrospective analysis of NDVH and TLH in a teaching hospital

Abstract

Introduction: Prior to medical advances in yester years VH was limited to uterine prolapse but in present techno-medical era the techniques and indications of vaginal hysterectomy have changed to give an excellent health care to women cosmetically at a reasonable cost with minimum invasion and maximum safety and satisfaction. Aims and objective: The aim of the study was to find out the answer of the question, IS REALLY TLH LESS INVASIVE THEN NDVH? By analyzing these two commonly performed procedures to find out the differences to decide whether NDVH is a simpler, less invasive, quicker, cost effective, environment friendly technique then TLH in the similar gynecological indications. Materials and Methods: A retrospective study was done on 120 randomly selected patient of Hysterectomy for various reasons between March 2016 till September 2017 in Dept. of Ob/Gyn LNMC JKH, Bhopal. Patients' original files and surgery reports of the TLH and VH were analyzed and compared retrospectively for the indication of surgery, patients' age, weight, parity, uterus size, time taken for surgery, blood loss, post-operative analgesia, hospital stay, Intra and post op complications. A stastical analysis of the data was performed using independent t test and p value of less than 0.01 was considered statically significant. Results: The mean time taken to perform TLH was significantly longer i.e. 184.83 minutes compared with NDVH, i.e. 83.5.minutes (p<0.004). Rate of conversion to AH was more with TLH due to haemorrhage in 3 and bladder injury in one of our cases, in comparison two cases in NDVH due to rectal and bladder injury. Blood loss in both the surgery was comparable as mean post op Hb in both group were 9.5 & 9.8 with no significant p value. Mean Pain score measured by VAS after 24 hours of surgery in TLH was 5.4+-2.02 and in NDVH was 3.57 +-1.3 after test of significance the p value was significant[<0.001] Proves that pain was less in NDVH than TLH. Duration of stay in the hospital was almost the same for both groups. Cost of surgery was more with TLH in comparison to NDVH. Conclusion: NDVH was as less invasive as TLH with the advantages of no visible scar on the abdomen, done under regional anaesthesia with routine instruments, less pain, less medication, less operative time, thus faster recovery so should be the first option whenever minimally invasive scar less hysterectomies is desired for similar indications.

Comparative Analysis of Total Laparoscopic Hysterectomy Versus Non-descent Vaginal Hysterectomy for Benign Uterine Pathologies in Women: A Systematic Review

“…In NDVH, there was a lower conversion to laparotomy (total AH) than in the TLH group, and similar results were reported by a retrospective analysis by Jain et al that indicated a higher conversion to AH in TLH due to hemorrhage, rectal injury, and bladder injury [31]. Additionally, the mean duration of hospital stay was higher in the TLH group in comparison to NDVH which correlated with the findings of previous studies by Chakraborty et al [3].…”