Changing practice from laparoscopic supracervical hysterectomy to total hysterectomy

To compare morbidity and mortality related to laparoscopic supracervical hysterectomy (LASH) and laparoscopic total hysterectomy (LTH).

We reviewed the medical records of 227 patients who underwent laparoscopic hysterectomy for benign gynaecological diseases between January 2004 and March 2008. Before January 2006, we performed mainly LASH (n: 122), and from January 2006 we performed LTH (n: 105). We reviewed and compared operating times, requirement for narcotics, duration of hospital stay, and complications of the two procedures.

The mean age of the patients in the LASH group was 45.7+/-0.6 years, and in the LTH group was 45.9+/-0.7 years. Patients in each group were comparable in mean body mass index and preoperative hemoglobin concentration. There were no differences in the duration of hospital stay or mean postoperative hemoglobin concentration. Patients in the LASH group had a shorter mean operating time than the LTH group (111.0+/-2.9 vs. 136+/-3.6 minutes; 95% CI 16-33, P<0.001), but the patients in the LASH group required a greater mean dose of narcotic than those in the LTH group (28.0+/-2.9 mg of morphine or morphine equivalent vs. 37.5+/-3.4 mg; 95% CI 1.5-10.5, P=0.02). There was no difference between the two groups in the incidence of major and minor complications. However, five patients in the LASH group required a repeat operation, but none of the LTH group did.

Laparoscopic total hysterectomy is associated with a longer operating time than laparoscopic supracervical hysterectomy, but with less need for postoperative narcotics.