100 total laparoscopic hysterectomies in private practice in Brazil

STUDY OBJECTIVE: To evaluate of 100 total laparoscopic hysterectomies performed in a private practice. DESIGN: Prospective observational study (Canadian Task Force classification II-2). SETTING: Private hospital. PATIENTS: One hundred women. INTERVENTIONS: Total laparoscopic hysterectomy (TLH). MEASUREMENTS AND MAIN RESULTS: The most common indications for TLH were chronic menorrhagia (uterine myomas), pelvic pain (severe endometriosis), and uterine enlargement. Four of our first 20 procedures were converted to laparotomy in which bipolar was used exclusively. In the others cases the Endo Gia stapler was used in the first step of the procedure (section of broad ligaments) in combination with bipolar coagulation. Mean operating time was 90 minutes (range 45-150 min) and hospital stay was 36 hours (range 18 hrs-2 days). The two intraoperative complications were hemorrhage requiring blood transfusion and a rectal injury; the four postoperative complications were two cases of vesicovaginal fistula, and one each of colonic vaginal fistula and vaginal cuff infection (total complication rate 5%). Ninety-six women returned to work in 2 weeks. CONCLUSION: Total laparoscopic hysterectomy can be performed safely and effectively when the surgical team is sufficiently trained and experienced in managing complications. We believe that it will become standard treatment for benign uterine disease. (J Am Assoc Gynecol Laparosc 6(2):169-171, 1999)