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Evaluation and the learning curve of the first one hundred laparoscopic hysterectomies
1Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Finland.
Background:
We analyzed the first one hundred laparoscopic hysterectomies done by one senior gynecologist to study the learning curve and complications of this technique.
Methods:
One hundred laparoscopic hysterectomies done for uterine fibroid (64%), menorrhagia (20%), adenomyosis or endometriosis (10%), cervical dysplasia (3%) and endometrial cancer (3%) were studied.
Results:
No conversion to laparotomy was needed. The weight of the uterus ranged from 70 to 470 grams (mean 206 g) and the operating time ranged from 45 to 245 minutes (mean 109 min). The mean operating time was reduced from 180 to 75 minutes. The uterine weight and the weight of the patient had a positive correlation to operating time. The use of automatic staplers or clips did not reduce the operating time. Ten complications occurred: one perforation of the urinary bladder, five bleedings and four pelvic infections.
Conclusion:
The operating time was clearly shortened during the first one hundred laparoscopic hysterectomies. The rate of the complications did not fall similarly. Technical complications (bladder perforation and intraoperative bleeding) occurred in the beginning. Complications like infection and bleeding do not seem to disappear with experience. Laparoscopic hysterectomy appears to be as safe as abdominal or vaginal hysterectomy and the postoperative convalescence time is short. It is clearly an acceptable alternative to hysterectomy.