Clinical outcome, inflammatory response and tissue trauma in total laparoscopic hysterectomy: comparison to laparoscopically-assisted vaginal hysterectomy.

OBJECTIVE: Our aim was quantify and compare the clinical outcome and surgical inflammatory response and tissue trauma between the total laparoscopic hysterectomy (TLH) and laparoscopically-assisted vaginal hysterectomy (LAVH). DESIGN: Clinical study. SETTING: Departments of Gynaecology, Obstetrics and Biochemistry, Hospital Kladno, Department of Biochemistry, Faculty Hospital Motol-Prague. METHODS: Fifty-eight patients scheduled for laparoscopic hysterectomy were selected according patients or doctor preference to undergo either TLH or LAVH operative technique. Blood samples for assay of markers of tissue trauma (C-reactive protein, interleukin-6, creatine kinase, cortisol, cystatin C, serotonin and white blood cells count) were taken preoperatively, on the first and third postoperative day. One patient with intraoperative complication (ureteral injury) was excluded from tissue analysis. RESULTS: No differences were present in the demographic characteristics and clinical outcomes (blood loss, complications and hospital stay) in fifty seven laparoscopic hysterectomies. The statistically significant difference was found only in duration of surgery (70 min in TLH group vs. 90 min in LAVH group, P < 0.05). This difference can be related to difference in uterine specimen weight (185 g in TLH group vs. 289 g in LAVH group, P < 0.02). Both the LAVH (n = 37) and TLH (n = 20) resulted in statistically significant changes in the inflammatory and systemic immune response in comparison with preoperative value. No significant differences were observed in the studied inflammatory and tissue markers between the studied operative techniques of laparoscopic hysterectomy. CONCLUSION: The total laparoscopic hysterectomy and laparoscopically-assisted vaginal hysterectomy were equally traumatic in terms of surgical inflammatory response and tissue trauma.