Optimizing the total laparoscopic hysterectomy procedure for benign uterine pathology

To evaluate the influence of the learning curve in total laparoscopic hysterectomy on short- and long-term clinical results.

Retrospective comparative analysis (Canadian Task Force classification II-2).

Malzoni Medical Center of Avellino, university-affiliated hospital.

Three hundred and ninety-six women in the first time period (1997-1999) and 624 women in the second time period (2000-2002) were treated, using different techniques, by the same surgeon. Patients suffered from symptomatic myomas and uterine fibromatosis. No case was considered suitable for a vaginal procedure.

Total laparoscopic hysterectomy.

No statistical differences were found between the two groups for patient age, parity, body mass index, and indications for surgery (p = NS), except for uterine weight (395 g vs. 408 g; p <.01). In the first time period, the average operating time was 105 +/- 27 minutes (range, from 65-190). In the second time period, the average operating time was 80 +/- 21 minutes (range, 45-170) (p <.001). The postoperative hemoglobin drop was 1.44 g/dL (range, 0.8-6.1) and 1.39 g/d (range, 0.7-4.3) in the first series and second series, respectively (p = NS). In the first series, the mean postoperative hospital stay was 2.4 +/- 1 days (range, 2-7). In the second series, the mean postoperative hospital stay was 2.3 +/- 1 days (range, 2-6). A significant decrease in short-term complications occurred between the first and second time period, 7.7% and 5.55% respectively (p <.03). We performed three (0.75%) and four (0.6%) conversion to laparotomy procedures, respectively, in the first and second groups (p = NS). During the first period, two reoperations were necessary; in the second period, one patient (0.15%) required a reoperation (p = NS). The rate of postoperative blood transfusion was 0.5% (n = 2) in the first period versus 0.15% (n = 1) in the second period (p = NS). Significant decrease of long-term complications occurred between first and second series, 2.0% and 0.45% respectively (p <.05). There were no differences between the two groups regarding sexual symptoms p = NS).

Laparoscopic hysterectomy is a safe, effective, and reproducible technique after completion of a period of training necessary to standardize the procedure. The results support the importance of optimizing some steps of the surgical technique to reduce severe complications.