Learning curve of laparoscopic hysterectomy and comparison with abdominal hysterectomy

Professor, India, Pooja Patil, Priyanka Sharma, Siftie-Kaur Banga
In: Obsgyne Review: Journal of Obstetric and Gynecology · 2019 · vol. 5(2) , pp. 112–118 · doi:10.17511/joog.2019.i02.05 · W3015350429
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This study compared abdominal and laparoscopic hysterectomy outcomes, finding that while laparoscopy reduced hospital stay and analgesic use, surgical time decreased significantly after the initial learning curve of 25 cases.

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⚙ AI-generated deep summary by qwen3.7-flash, 2026-09-03 · read from full text ⓘ

This study compared surgical outcomes between total abdominal hysterectomy and total laparoscopic hysterectomy in a cohort of 100 patients. The results indicated that while laparoscopic surgery required significantly more operative time, it resulted in lower blood loss, reduced analgesic requirements, and shorter hospital stays compared to the abdominal approach. A notable finding was the steep learning curve for laparoscopy, with surgical duration and blood loss decreasing significantly after the initial twenty-five cases. Relevance to endometriosis: adenomyosis is listed as one of the main indications for hysterectomy in this study, though the paper's primary focus is comparing surgical routes rather than specific pathology management.

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Abstract

Introduction: Laparoscopic hysterectomy is the most emerging route with major drawback of long learning curve and longer initial time taken for surgery. Objectives: 1) To compare two different routes of hysterectomy: abdominal and laparoscopic in terms of surgical outcomes and complications. 2) To see the learning curve of laparoscopic hysterectomy. Material and Methods: 100 patients admitted for hysterectomy were divided into two groups of 50 each, first group planned for abdominal hysterectomy and second group planned for laparoscopic route. Data was collected regarding amount of blood loss, duration of surgery, post operative requirement of analgesics, duration of hospital stay, and post operative complications in both groups. Results: The main indications for hysterectomy were fibroid, AUB, adenomyosis, endometrial hyperplasia and polyp in both groups. The average blood loss in TAH group (n=50) was 285 ml and in TLH group (n=50) was 246 ml (p=0.0588). Average blood loss in first 25 cases of TLH was 348 ml and in next 25 cases was 144 ml, which was highly significant. The average time taken in TAH group was 95 minutes, and in TLH group was 141 minutes (p=1.415E-13) which was highly significant. In TLH group, the average time taken in first 25 cases was 166 minutes and in next 25 cases it was 116 minutes which is significant. Requirement of analgesics and duration of stay was less in TLH group. Minor complications like fever, UTI were comparable in both groups. Conclusion: Learning curve of laparoscopic hysterectomy can be reduced with good team work, a proper selection of patients, and the use of good instruments.
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Introduction

Laparoscopic hysterectomy is the most emerging route with major drawback of long learning curve and longer initial time taken for surgery.

Objectives

1) To compare two different routes of hysterectomy: abdominal and laparoscopic in terms of surgical outcomes and complications. 2) To see the learning curve of laparoscopic hysterectomy.

Material and methods

100 patients admitted for hysterectomy were divided into two groups of 50 each, first group planned for abdominal hysterectomy and second group planned for laparoscopic route. Data was collected regarding amount of blood loss, duration of surgery, post operative requirement of analgesics, duration of hospital stay, and post operative complications in both groups.

Results

The main indications for hysterectomy were fibroid, AUB, adenomyosis, endometrial hyperplasia and polyp in both groups. The average blood loss in TAH group (n=50) was 285 ml and in TLH group (n=50) was 246 ml (p=0.0588). Average blood loss in first 25 cases of TLH was 348 ml and in next 25 cases was 144 ml, which was highly significant. The average time taken in TAH group was 95 minutes, and in TLH group was 141 minutes (p=1.415E-13) which was highly significant. In TLH group, the average time taken in first 25 cases was 166 minutes and in next 25 cases it was 116 minutes which is significant. Requirement of analgesics and duration of stay was less in TLH group. Minor complications like fever, UTI were comparable in both groups.

Conclusion

Learning curve of laparoscopic hysterectomy can be reduced with good team work, a proper selection of patients, and the use of good instruments. Downloads

References

2. Marana R, Busacca M, Zupi E, et al. Laparos-copically assisted vaginal hysterectomy versus total abdominal hysterectomy: a prospective, randomized, multicenter study. Am J Obstet Gynecol. 1999; 180(2 Pt 1):270-5. DOI:10.1016/s0002-9378 (99)70199-7 3. McCracken G, Hunter D, Morgan D, Price JH. Comparison of laparoscopic– assisted vaginal hysterectomy, total abdominal hysterectomy and vaginal hysterectomy. Ulster Med J. 2006; 75(1): 54-58. 4. Kanmani, M., Mirudhubashini, G., Vishranthi, S. Comparative study of surgical results between total abdominal hysterectomy and total laparoscopic hysterectomy in a tertiary hospital: a 2 year retros-pective study. Int. J Reprod Contracept Obstet Gynecol. 2018;7(3):1019-1023. DOI: http://dx.doi.org/ 10. 18203 /2320-1770.ijrcog20180884. 5. Nanavati AM, Gokral SB. A prospective randomized comparative study of vaginal, abdominal, and laparoscopic hysterectomies. J Obstet Gynecol India. 2016; 66 (1):389-94.DOI: 10.1007/s13224-015-0756-z. 6. Terzi H, Biler A, Demirtas O, Guler OT, Peker N, Kale A Terzi H, Biler A, Demirtas O. Total laparos-copic hysterectomy: Analysis of the surgical learning curve in benign conditions. Int J Surg. 2016;35:51-57. DOI: 10.1016/j.ijsu.2016.09.010. 7. Balcı O. Comparison of total laparoscopic hysterectomy and abdominal hysterectomy.Turk J Obstet Gynecol. 2014;11(4):224-227. DOI:10.4274/ tjod. 47108. 8. Kim SM, Park EK, Jeung IC, Kim CJ, Lee YS. Abdominal, multi-port and single-port total laparos-copic hysterectomy: eleven-year trends comparison of surgical outcomes complications of 936 cases. Arch Gynecol Obstet. 2015;291(6):1313-9. DOI: 10.1007/s 00404-014-3576-y. 9. Garry R, Fountain J, Brown J, Manca A, Mason S, Sculpher M, et al. Evaluate hysterectomy trial: a multicentre randomised trial comparing abdominal, vaginal and laparoscopic methods of hysterectomy. Health Technol Assess. 2004;8(26):1-154.DOI:https:// doi.org/10.3310/hta8260 10. Perino A, Cucinella G, Venezia R, Castelli A, Cittadini E. Total laparoscopic hysterectomy versus total abdominal hysterectomy: an assessment of the learning curve in a prospective randomized study. Human Reproduction. 1999;14(12):2996-9.DOI: https:// doi. org/ 10.1093/humrep/14.12.2996 11. Sutasanasuang S. Laparoscopic hysterectomy versus total abdominal hysterectomy: a retrospective comparative study. J Med Assoc Thai. 2011;94(1):8-16. 12. Yi YX, Zhang W, Zhou Q, Guo WR, Su Y. Laparoscopic- assisted vaginal hysterectomy vs abdominal hysterectomy for benign disease: a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2011;159(1):1-18. DOI: 10.1016 / j. ejogrb.2011.03.033. 13. Kluivers KB, Hendriks JC, Mol BW, Bongers MY, Bremer GL, de Vet HC, et al. Quality of life and surgical outcome after total laparoscopic hysterectomy versus total abdominal hysterectomy for benign disease: a randomized, controlled trial. J Minim Invasive Gynecol. 2007;14(2):145-52. DOI:10.1016/j.jmig.2006. 08.009

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adenomyosis

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