Total laparoscopic hysterectomy for endometrial neoplasia

Abstract

Total laparoscopic hysterectomy and bilateral salpingo-oophorectomy (TLH) offers an alternative and potentially more favourable procedure for women with early endometrial neoplasia. This cohort review presents the first 66 consecutive cases of TLH for endometrial neoplasia from one surgical team in a large teaching hospital. Data were collected for all women undergoing hysterectomy for suspected endometrial cancer, grade 1-2 adenocarcinoma, carcinoma in situ or severe atypical hyperplasia over 4 years using a prospectively kept theatre database. A total of 95 hysterectomies were identified, 66 (69%) underwent TLH, 18 (19%) underwent laparoscopically assisted vaginal hysterectomy (LAVH) and 11 (12%) had total abdominal hysterectomy (TAH) procedures. The mean age and body mass index of the patients in each group were similar, and average blood loss was lower in the TLH group (129 ml) compared to LAVH (185 ml) or TAH (247 ml). Total theatre time for TLH (113 min) was similar to LAVH (112 min) and less than the TAH group (127 min). Conversion rate from TLH to TAH was 0%. There were no major complications in the TLH group. These data report our early experience with a TLH and demonstrate a satisfactory record during its introduction. This new procedure offers a safe alternative to TAH for many women with no increased morbidity in agreement with recent literature. Although this paper reports a non-randomised series, we hope that it will serve to show that these techniques can be adopted safely by a new unit.