Implementation of Total Laparoscopic Hysterectomy As the Default Technique and Lessons Learnt

Area of Science:

• Gynaecology
• Minimally Invasive Surgery
• Surgical Outcomes

Background:

• Slow adoption of Total Laparoscopic Hysterectomy (TLH) in Australia and New Zealand due to concerns about complications and lack of audits.
• Majority of gynaecologists prefer TLH for its less-invasive nature.

Purpose of the Study:

• Assess TLH implementation as the default hysterectomy method at a private New Zealand institution.
• Identify factors associated with perioperative complications and laparoscopic failure.
• Analyze outcomes in an unselected patient population over fourteen years.

Main Methods:

• Retrospective review of 1,287 hysterectomy cases over 14 years.
• Emphasis on demographics, outcomes, indications, laparoscopic completion rates, and perioperative complications.
• Statistical analysis to identify factors associated with complications and conversion rates.

Main Results:

• 11.7% nulliparous patients, 29.4% with prior laparotomy.
• Mean operative time: 144.84 min, mean blood loss: 137.24 mL, mean hospital stay: 2.07 days.
• Conversion to laparotomy in 0.93% of cases, significantly associated with uterine weight.
• Main indications: menorrhagia/dysmenorrhoea (51.4%) and fibroids (17.7%).
• Overall perioperative complications: 5.7%, major complications: 1.24%.
• BMI and uterine weight significantly associated with major complications and conversion rates.

Conclusions:

• TLH is an achievable and safe default surgical approach for hysterectomy.
• Uterine weight and BMI are significant predictors of major complications and conversion to laparotomy.
• Audit and data collection are crucial for safe implementation of TLH.