Single-Centre Experience of Doing Safe Total Laparoscopic Hysterectomy: Retrospective Analysis of 1200 Cases

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This retrospective study analyzed 1200 total laparoscopic hysterectomies performed at a high-volume tertiary care center, finding it to be a safe and feasible procedure with manageable complications.

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This retrospective observational study evaluated safety and feasibility of total laparoscopic hysterectomy (TLH) in a high-volume tertiary care training hospital, analyzing 1200 women treated between July 2013 and June 2019 by trained surgeons. Key outcomes included demographics, surgical indications, surgical time, intra-operative blood loss, post-operative complications, hospital stay, discharge, and follow-up, with TLH reported as successfully performed in all cases; intra-operative complications occurred in 2.00% and post-operative complications in 7.58%, which were managed successfully. The paper’s main limitation is that it is single-centre and retrospective, without a comparison group to contextualize relative safety or effectiveness. Relevance to endometriosis: the indications list includes endometriosis (3.33% of cases), though the paper’s main focus is overall TLH safety and feasibility across multiple benign gynecologic indications, including adenomyosis.

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Abstract

Study Objective Assessment of safety and feasibility of total laparoscopic hysterectomy in a high-volume tertiary care centre. Design Retrospective study design. Setting Tertiary care centre: Galaxy care Hospital, Pune, India.

Materials and methods

This is a retrospective observational study conducted in a tertiary care resident training hospital in Pune which is a high-volume teaching hospital. 1200 total laparoscopic hysterectomy patients between July 2013 and June 2019 operated by a group of trained surgeons were analysed, and parameters, namely demography, indication of surgery, surgical time, intra-operative blood loss, post-operative complications, duration of hospital stay, discharge and follow-up, were studied. Result(s) A total of 1200 women who underwent total laparoscopic hysterectomy for various indications were included in the study. TLH was successfully performed in all women. Mean age of women was 45 years. 72.00% had a BMI between 18.5 and 24.9, 16.08% had a BMI between 25 and 29.9, 3.92% had a BMI of > 29.9 while 8% had a BMI < 18.5. Indications for surgery included uterine fibroid (33.08%), adenomyosis (22.25%), endometrial hyperplasia (14.33%), endometrial polyp (7%), endometriosis (3.33%), postmenopausal bleeding (9.25%), chronic PID (5.25%), prolapse (4.25%) and risk reduction surgery in 1.25%. 2.00% had intra-operative complications while 7.58% had post-operative complications which were identified and managed successfully. Conclusion(s) Advances and innovation in equipment, energy sources and surgical training have made TLH a well-tolerated and efficient surgery. Irrespective of the previous morbidity, pathology and uterine size, TLH is a duplicable and safe in a well-trained high-volume centre. Similar content being viewed by others Abbreviations - TLH: - Total laparoscopic hysterectomy - BMI: - Body mass index - LSCS: - Lower segment caesarean section - LH: - Laparoscopic hysterectomy - LAVH: - Laparoscopic-assisted vaginal hysterectomy - CO2: - Carbon dioxide - POD: - Post-operative day - LSCH: - Laparoscopic-assisted supracervical hysterectomy - LH: - Laparoscopic hysterectomy - N: - Number - PID: - Pelvic inflammatory disease - Fig: - Figure

References

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