Laparoscopic Hysterectomy, The Worcester Experience

Despite the enthusiasm in the gynecologic community and the lay press for laparoscopic hysterectomy, there remain few articles to date in the literature supporting this new surgical technique. Those papers that have been published review the laparoscopic hysterectomy experience of the most advanced pelviscopic surgeons. However, the majority of patients inquiring about this surgery are presenting to generalists in obstetrics and gynecology. This paper differs from those previously published in that it examines a community's experience with the first 108 attempted laparoscopic hysterectomies. Areas that were analyzed included indications for surgery, type of laparoscopic hysterectomy, instrument preference, failure to complete operation, complications and relative cost. A retrospective analysis was performed of hospital and office charts using a standardized collection sheet. Laparoscopic-assisted vaginal hysterectomy in which the uterine vessels are controlled vaginally was the most common operative technique used in the Worcester community from August 1991 to December 1992. Surgical indications, patient demographics, and complication rates were comparable with previously published papers. However, our data showed no improvement in estimated blood loss or operating room time with increased operator experience. Pathology reports were reviewed and there were no cases in which an unsuspected malignancy was encountered. This data is presented to evaluate a new surgical procedure and its introduction into the community. In order to reach a consensus on the validity of laparoscopic hysterectomy, continued evaluation will be necessary.