Outcomes of Laproscopic Hysterectomies: An assessment of a learning curve experience of a Gynae laparoscopic surgeries

Mahwish Fatima, Sadaf Maqsood, Sarwat Laqa, Samra Kashif, Sana Rehman, Zubaida Masood
In: Pakistan Journal of Health Sciences · 2022 · pp. 20–24 · doi:10.54393/pjhs.v3i07.293 · W4313827750
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This prospective case series of 50 patients found that laparoscopic hysterectomy is a safe alternative for benign uterine pathology up to 12 weeks size, with adenomyosis being the primary indication in 40% of cases.

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This prospective case series evaluated the outcomes of total laparoscopic hysterectomies performed on fifty patients with benign uterine pathology, specifically focusing on a learning curve experience. The study found that while the procedure is generally safe for uteri up to twelve weeks in size, it was associated with a high complication rate of forty percent and required conversion to laparotomy in eight cases due to hemorrhage. Adenomyosis was identified as the primary indication for surgery in twenty of the enrolled patients, highlighting its role as a significant benign condition requiring this intervention. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

Among the most frequent gynecological operations conducted is the hysterectomy. Objective: To determine the outcome of TLH in benign uterine pathology of up to 12-week size uterus. Methods: It was a prospective case series carried out at Obstetrics and Gynecology department of Memon medical institute hospital, Karachi from January 2019 to January 2021. All patients who underwent laparoscopic hysterectomy secondary to benign utero- ovarian pathology were consecutively enrolled. Demographic characteristics of the patients along with the presence of co-morbidities, hospital admission details, surgical procedure and intra and post-operative complications were noted. The surgery performed with similar technique in all cases. If patients were deemed to be fit for release after 48 hours following surgery, they were discharged. The postoperative follow-ups were performed at 10th, 30th, and 3 months. Results: Of 50 patients, the mean age was 50.5 years. The main indication of hysterectomy is adenomyosis diagnosed in 20 patients. There were 4 laparoscopic assisted vaginal hysterectomies and 46 were total laparoscopic hysterectomies. History of previous laparotomies was observed in 12, previous cesarean and bilateral tubal ligation in 6 each, history of mesh repair of umbilical hernia in 4 while history of VP shunt was observed in 2 patients. Eight patients converted into laparotomy due to technical difficulty in controlling hemorrhage of uterine artery. Total rate of intra and post-operative complications was 40%. Conclusion: Laparoscopic approach for hysterectomy is a safe alternative to conventional hysterectomy for benign uterine pathology of up to 12 weeks size uterus.
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Outcomes of Laproscopic Hysterectomies: An assessment of a learning curve experience of a Gynae laparoscopic surgeries Assessment of a Learning Curve Experience of Gynae Laparoscopic Surgeries DOI: https://doi.org/10.54393/pjhs.v3i07.293Keywords: Gynecological Surgical Procedures, Laparoscopy, Hysterectomy, Postoperative Complications, Treatment OutcomeAbstract Among the most frequent gynecological operations conducted is the hysterectomy. Objective: To determine the outcome of TLH in benign uterine pathology of up to 12-week size uterus. Methods: It was a prospective case series carried out at Obstetrics and Gynecology department of Memon medical institute hospital, Karachi from January 2019 to January 2021. All patients who underwent laparoscopic hysterectomy secondary to benign utero- ovarian pathology were consecutively enrolled. Demographic characteristics of the patients along with the presence of co-morbidities, hospital admission details, surgical procedure and intra and post-operative complications were noted. The surgery performed with similar technique in all cases. If patients were deemed to be fit for release after 48 hours following surgery, they were discharged. The postoperative follow-ups were performed at 10th, 30th, and 3 months. Results: Of 50 patients, the mean age was 50.5 years. The main indication of hysterectomy is adenomyosis diagnosed in 20 patients. There were 4 laparoscopic assisted vaginal hysterectomies and 46 were total laparoscopic hysterectomies. History of previous laparotomies was observed in 12, previous cesarean and bilateral tubal ligation in 6 each, history of mesh repair of umbilical hernia in 4 while history of VP shunt was observed in 2 patients. Eight patients converted into laparotomy due to technical difficulty in controlling hemorrhage of uterine artery. Total rate of intra and post-operative complications was 40%. Conclusion: Laparoscopic approach for hysterectomy is a safe alternative to conventional hysterectomy for benign uterine pathology of up to 12 weeks size uterus. References Walsh CA, Walsh SR, Tang TY, Slack M. Total abdominal hysterectomy versus total laparoscopic hysterectomy for benign disease: a meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2009 May; 144(1):3-7. doi: 10.1016/j.ejogrb.2009.01.003 Ashfaq S, Samina M, Jabeen M, Zafar S. Outcomes of Total Laparoscopic Hysterectomy: A Single-Surgeon Experience of Initial 50 Cases. Cureus. 2021 Jan; 13(1):e12644. doi: 10.7759/cureus.12644 Shrestha R, Yu LH. Comparison between laparoscopic hysterectomy and abdominal hysterectomy. Nepal Journal of Obstetrics Gynecology. 2014 Sep; 9(1):26-8. doi: 10.3126/njog.v9i1.11183 Dogra A, Vinay K, Nishu B. TLH versus TAH: a 2-year retrospective comparative study. 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Gynecological Surgery. 2018 Nov, 15(1):19. doi: 10.1186/s10397-018-1052-6 Kim SM, Park EK, jeung JC, Kim CJ, Lee YS. Abdominal, multi –port and single –port total laparoscopic hysterectomy: eleven years trends comparison of surgical outcomes complication of 936 cases. Archives of Gynecological Obstetrics. 2015 Jun; 291:1313-9. doi: 10.1007/s00404-014-3576-y Istre O, Snejbjerg D. Complication Rate of Laparoscopic Hysterectomies in Denmark, 2011-2016. Journal of the Society of Laparoendoscopic Surgeons. 2018 Jan; 22(1):e2017.00078. doi: 10.4293/JSLS.2017.00078 Dojki SS, Bano A. Outcome of Total Laparoscopic Hysterectomy. Journal of the College of Physicians and Surgeons Pakistan. 2018 Jun; 28(6):427-30. doi: 10.29271/jcpsp.2018.06.427 Ng CC, Chern BS, Siow AY. Retrospective study of the success rates and complication associated with total laparoscopic hysterectomy. Journal of Obstetrics Gynecology Research. 2007 Aug; 33:512-518. doi: 10.1111/j.1447-0756.2007.00577.x Sandberg EM, Twijnstra ARH, Driessen SRC, Jansen FW. Total Laparoscopic Hysterectomy Versus Vaginal Hysterectomy: A Systematic Review and Meta-Analysis. Journal of Minimum Invasive Gynecology. 2017 Feb; 24(2):206-217. doi: 10.1016/j.jmig.2016.10.020. Ishibashi T, Nakayama K, Razia S, Yamashita H, Ishikawa M, Sato S, et al. Impact of Uterine Size on Outcomes of Total Laparoscopic Hysterectomy for Uterine Leiomyomas. Clinical and Experimental Obstetrics & Gynecology. 2022 Aug; 49(8):185. doi: 10.31083/j.ceog4908185 Ghosh D, Wipplinger P, Byrne DL. Can total laparoscopic hysterectomy replace total abdominal hysterectomy? A 5-year prospective cohort study of a single surgeon's experience in an unselected population. Gynecological Surgery. 2013 May; 10(2):109-15. doi: 10.1007/s10397-012-0754-4 O'Hanlan KA, Huang GS, Garnier AC, Dibble SL, Reuland ML, Lopez L, et al. Total laparoscopic hysterectomy versus total abdominal hysterectomy: cohort review of patients with uterine neoplasia. Journal of the Society of Laparoendoscopic Surgeons. 2005 Jul; 9(3):277. Kehde BH, van Herendael BJ, Tas B, Jain D, Helsen K, Jochems L. Large uterus: what is the limit for a laparoscopic approach? Autopsy & Case Reports. 2016 Jan; 6(1):51. doi: 10.4322/acr.2016.025 Wang H, Li P, Li X, Gao L, Lu C, Zhao J, et al. Total laparoscopic hysterectomy in patients with large uteri: comparison of uterine removal by transvaginal and uterine morcellation approaches. BioMed Research International. 2016 Jun; 2016:8784601. doi: 10.1155/2016/8784601 Downloads Published How to Cite Issue Section License Copyright (c) 2022 Pakistan Journal of Health Sciences This work is licensed under a Creative Commons Attribution 4.0 International License. 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