Experience in laparoscopic hysterectomy: analysis of three hundred cases.

A personal experience with 300 cases of laparoscopic hysterectomy was analysed and its merits and demerits were discussed. The demographic features, indications, feasibility, complications, operating time, blood loss, hospital stay, cost effectiveness and its outcome were reviewed. The indications were uterine fibroid (40%), adenomyosis, dysfunctional uterine bleeding and pelvic inflammatory disease (36%), fibroid uterus with endometriosis (17.5%), postmenopausal bleeding (3%), ovarian neoplasm (2.1%) and fibroid uterus with ovarian cyst (1.4%). Two uterine malignancies and one case of potentially malignant ovarian neoplasm, were also encountered in our series. Assessibility score of above 20 was present in 55%. Haemorrhage was prevented intraoperatively by securing the large pedicles with electrocoagulation as well as large titanium clips (LT-400). Retrograde ureteric catheterisation was not necessary. Overall morbidity was present only in 10.62%. Intraoperative bladder injury was encountered in 1%, urinary fistula in 0.66%, primary and secondary haemorrhage in 0.33% respectively, and minor febrile morbidity in 4.66%. Conversion to conventional abdominal hysterectomy occurred in 0.66% of the cases. The average operating time was 141.99 +/- 31.678 min, the estimated blood loss was 237.07 +/- 76.76 ml and average hospitalisation was 3.37 +/- 0.66 days. The cost of laparoscopic hysterectomy was found similar to abdominal hysterectomy. Higher operating fee, operating theatre and anaesthesia charges did not affect the overall cost of laparoscopic hysterectomy because of shorter hospital stay. It is concluded that laparoscopic hysterectomy has definite role in gynaecological surgery.