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This retrospective study evaluated outcomes for 293 patients who underwent hysterectomy for uterine myoma or adenomyosis between 2008 and 2013. The researchers compared total laparoscopic hysterectomy (TLH) with laparoscopically assisted vaginal hysterectomy (LAVH) and abdominal total hysterectomy (ATH), finding that TLH had significantly longer operating times but lower intraoperative blood loss. While the proportion of TLH cases increased to nearly 73% by 2013, a conversion rate to laparotomy of 9.2% was observed in laparoscopic procedures, alongside specific postoperative complications such as uretero-vaginal fistulas. The authors concluded that increasing clinical proficiency in TLH is improving its safety and effectiveness over time. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.
Abstract
Objective: We aimed to clarify the trends in outcomes of various types of hysterectomy in our hospital. We also assessed the factors that influenced operating time and intraoperative blood loss in patients who underwent hysterectomy.Design: We conducted a retrospective study and evaluated a total of 293 patients who underwent abdominal or laparoscopic hysterectomy between 2008 and 2013.Main Outcome and Measure(s): We measured operating time, intraoperative blood loss, uterine weight, and surgical complications.Result(s): The proportion of total laparoscopic hysterectomy (TLH) performed has been increasing in recent years. In 2013, TLH accounted for 72.9% of all cases of hysterectomy in our facility. Fourteen of 152 patients (9.2%) in our study who underwent laparoscopic surgery required conversion to laparotomy. Median operating time in TLH was significantly longer than in laparoscopically assisted vaginal hysterectomy (LAVH) and abdominal total hysterectomy (ATH). Median intraoperative blood loss was significantly lower in TLH than in LAVH and ATH. Median weight of the uterus removed by ATH was greater than that removed by LAVH and TLH. In laparoscopic hysterectomy, there was a positive correlation between uterine weight and operating time. Intraoperative complications occurred in two LAVH patients and in four TLH patients. Postoperative complications in the TLH group included two cases of uretero-vaginal fistula and one case of hematoma of the vaginal cuff. Postoperative complications occurred in four cases in the ATH group.Conclusion(s): Our clinical proficiency with TLH is increasing, and we believe that continued experience and technical improvements in laparoscopic hysterectomy will lead to improved safety and effectiveness of the procedure.
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原著論文
子宮筋腫および子宮腺筋症に対して施行した子宮全摘術293例における後方視的検討（過去6年間）
2014 年 30 巻 1 号 p. 106-111
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Objective: We aimed to clarify the trends in outcomes of various types of hysterectomy in our hospital. We also assessed the factors that influenced operating time and intraoperative blood loss in patients who underwent hysterectomy.
Design: We conducted a retrospective study and evaluated a total of 293 patients who underwent abdominal or laparoscopic hysterectomy between 2008 and 2013.
Main Outcome and Measure(s): We measured operating time, intraoperative blood loss, uterine weight, and surgical complications.
Result(s): The proportion of total laparoscopic hysterectomy (TLH) performed has been increasing in recent years. In 2013, TLH accounted for 72.9% of all cases of hysterectomy in our facility. Fourteen of 152 patients (9.2%) in our study who underwent laparoscopic surgery required conversion to laparotomy. Median operating time in TLH was significantly longer than in laparoscopically assisted vaginal hysterectomy (LAVH) and abdominal total hysterectomy (ATH). Median intraoperative blood loss was significantly lower in TLH than in LAVH and ATH. Median weight of the uterus removed by ATH was greater than that removed by LAVH and TLH. In laparoscopic hysterectomy, there was a positive correlation between uterine weight and operating time. Intraoperative complications occurred in two LAVH patients and in four TLH patients. Postoperative complications in the TLH group included two cases of uretero-vaginal fistula and one case of hematoma of the vaginal cuff. Postoperative complications occurred in four cases in the ATH group.
Conclusion(s): Our clinical proficiency with TLH is increasing, and we believe that continued experience and technical improvements in laparoscopic hysterectomy will lead to improved safety and effectiveness of the procedure.
Design: We conducted a retrospective study and evaluated a total of 293 patients who underwent abdominal or laparoscopic hysterectomy between 2008 and 2013.
Main Outcome and Measure(s): We measured operating time, intraoperative blood loss, uterine weight, and surgical complications.
Result(s): The proportion of total laparoscopic hysterectomy (TLH) performed has been increasing in recent years. In 2013, TLH accounted for 72.9% of all cases of hysterectomy in our facility. Fourteen of 152 patients (9.2%) in our study who underwent laparoscopic surgery required conversion to laparotomy. Median operating time in TLH was significantly longer than in laparoscopically assisted vaginal hysterectomy (LAVH) and abdominal total hysterectomy (ATH). Median intraoperative blood loss was significantly lower in TLH than in LAVH and ATH. Median weight of the uterus removed by ATH was greater than that removed by LAVH and TLH. In laparoscopic hysterectomy, there was a positive correlation between uterine weight and operating time. Intraoperative complications occurred in two LAVH patients and in four TLH patients. Postoperative complications in the TLH group included two cases of uretero-vaginal fistula and one case of hematoma of the vaginal cuff. Postoperative complications occurred in four cases in the ATH group.
Conclusion(s): Our clinical proficiency with TLH is increasing, and we believe that continued experience and technical improvements in laparoscopic hysterectomy will lead to improved safety and effectiveness of the procedure.
© 2014 日本産科婦人科内視鏡学会
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