Percutaneous-Assisted versus Laparoscopic Hysterectomy: A Prospective Comparison

Area of Science:

• Gynecologic Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Laparoscopic hysterectomy (LPS-H) is a standard minimally invasive surgical (MIS) approach.
• Evaluating novel MIS techniques like percutaneous-assisted hysterectomy (PSS-H) is crucial for improving patient outcomes.

Purpose of the Study:

• To assess the feasibility and compare the outcomes of percutaneous-assisted hysterectomy (PSS-H) against traditional laparoscopic hysterectomy (LPS-H).
• To evaluate intraoperative, postoperative, and cosmetic outcomes in patients undergoing PSS-H versus LPS-H.

Main Methods:

• A multicentric cohort study comparing 80 patients undergoing PSS-H with 80 patients undergoing LPS-H for benign and malignant gynecological conditions.
• Data collected included preoperative characteristics, operative time, estimated blood loss, intraoperative and 30-day complications, postoperative pain (visual analog scale), and cosmetic outcomes.
• Thirty cases of low-/intermediate-risk endometrial cancer were included in each group.

Main Results:

• No significant differences in baseline characteristics or operative time between PSS-H and LPS-H.
• PSS-H demonstrated significantly lower estimated blood loss (50 cc vs. 100 cc) and fewer intraoperative complications (1.3% vs. 5.0%).
• While postoperative pain was similar, PSS-H showed significantly better cosmetic outcomes (p = 0.0001). Oncological outcomes were comparable for both techniques.

Conclusions:

• Percutaneous-assisted hysterectomy (PSS-H) is comparable to laparoscopic hysterectomy (LPS-H) regarding intraoperative, perioperative outcomes, and postoperative pain.
• PSS-H appears superior in terms of cosmetic results and patient satisfaction.
• PSS-H represents a viable ultra-MIS alternative for benign gynecological conditions and select endometrial cancers.