Total laparoscopic hysterectomy versus total abdominal hysterectomy

cohort review of patients with uterine neoplasia.

Katherine A. O'Hanlan, Gloria Shining Huang, Anne Caroline Garnier, Suzanne L. Dibble, Mirjam L. Reuland, Lisbeth Lopez, Rebecca L. Pinto

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

OBJECTIVE: Retrospective analysis of surgico-pathologic data comparing total laparoscopic hysterectomy (TLH) with total abdominal hysterectomy (TAH) patients with uterine neoplasia. METHODS: We conducted a chart abstraction of all patients undergoing hysterectomy for uterine neoplasia from September 1996 to November 2004. Patients were assigned to undergo the abdominal or laparoscopic approach based on established clinical safety criteria. RESULTS: The study included 105 patients, 29 with TAH and 76 with TLH. TAH patients were older (68 vs. 61, P=0.021); however, both groups had similar body mass indexes (31) and parities (1.6). Controlling for age, surgical duration was similar (152 minutes). Average blood loss was higher for TAH, (504 vs. 138 mL, P<0.001). Hospital stays were significantly longer for patients with TAH than for those with TLH (5.4 vs. 1.8 days, P<0.0001). Uterine weight was greater (197 vs. 135 g, P=0.008) and myometrial invasion deeper in the TAH group (48% outer half vs. 17%, P=0.001). More patients had Stage II or higher disease in the TAH group (35% vs. 17%, P=0.038). More TAH patients needed node dissection (79% vs. 28%, P<.001). Node yields from dissections of 23 TAH cases and 21 laparoscopic cases were similar (17 nodes). Total and reoperative complications from TAH versus TLH were not statistically different in our small sample (14.3 vs. 5.2% total, NS; 10.3 vs. 2.6% reoperative). One conversion was necessary from laparoscopy to laparotomy for unsuspected bulky metastatic disease. CONCLUSION: Based on clinical selection criteria, TLH performed for endometrial pathology has few complications and is well tolerated by select patients. The advantages are less blood loss and a shorter length of hospital stay for qualified patients.

Original languageEnglish (US)
Pages (from-to)277-286
Number of pages10
JournalJSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Volume9
Issue number3
StatePublished - 2005
Externally publishedYes

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Hysterectomy
Neoplasms
Length of Stay
Dissection
Parity
Laparoscopy
Laparotomy
Patient Selection
Body Mass Index

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Total laparoscopic hysterectomy versus total abdominal hysterectomy : cohort review of patients with uterine neoplasia. / O'Hanlan, Katherine A.; Huang, Gloria Shining; Garnier, Anne Caroline; Dibble, Suzanne L.; Reuland, Mirjam L.; Lopez, Lisbeth; Pinto, Rebecca L.

In: JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons, Vol. 9, No. 3, 2005, p. 277-286.

Research output: Contribution to journalArticle

O'Hanlan, Katherine A. ; Huang, Gloria Shining ; Garnier, Anne Caroline ; Dibble, Suzanne L. ; Reuland, Mirjam L. ; Lopez, Lisbeth ; Pinto, Rebecca L. / Total laparoscopic hysterectomy versus total abdominal hysterectomy : cohort review of patients with uterine neoplasia. In: JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons. 2005 ; Vol. 9, No. 3. pp. 277-286.
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AU - O'Hanlan, Katherine A.

AU - Huang, Gloria Shining

AU - Garnier, Anne Caroline

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AU - Reuland, Mirjam L.

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AU - Pinto, Rebecca L.

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AB - OBJECTIVE: Retrospective analysis of surgico-pathologic data comparing total laparoscopic hysterectomy (TLH) with total abdominal hysterectomy (TAH) patients with uterine neoplasia. METHODS: We conducted a chart abstraction of all patients undergoing hysterectomy for uterine neoplasia from September 1996 to November 2004. Patients were assigned to undergo the abdominal or laparoscopic approach based on established clinical safety criteria. RESULTS: The study included 105 patients, 29 with TAH and 76 with TLH. TAH patients were older (68 vs. 61, P=0.021); however, both groups had similar body mass indexes (31) and parities (1.6). Controlling for age, surgical duration was similar (152 minutes). Average blood loss was higher for TAH, (504 vs. 138 mL, P<0.001). Hospital stays were significantly longer for patients with TAH than for those with TLH (5.4 vs. 1.8 days, P<0.0001). Uterine weight was greater (197 vs. 135 g, P=0.008) and myometrial invasion deeper in the TAH group (48% outer half vs. 17%, P=0.001). More patients had Stage II or higher disease in the TAH group (35% vs. 17%, P=0.038). More TAH patients needed node dissection (79% vs. 28%, P<.001). Node yields from dissections of 23 TAH cases and 21 laparoscopic cases were similar (17 nodes). Total and reoperative complications from TAH versus TLH were not statistically different in our small sample (14.3 vs. 5.2% total, NS; 10.3 vs. 2.6% reoperative). One conversion was necessary from laparoscopy to laparotomy for unsuspected bulky metastatic disease. CONCLUSION: Based on clinical selection criteria, TLH performed for endometrial pathology has few complications and is well tolerated by select patients. The advantages are less blood loss and a shorter length of hospital stay for qualified patients.

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