Comparison of different types of minimal invasive hysterectomy surgery in treatment of gynecologic benign and pre-malignant disease

[Objective] To compare and assess the clinical outcomes of different types of minimal invasive surgery (MIS) in treatment of gynecologic benign disease or pre-malignant disease. [Methods] A Retrospective study. 523 patients diagnosed as gynecologic benign and pre-malignant diseases were undergone total hysterectomy with MIS by the same surgical team from 1996 to 2005. Of these patients, 318(61%) were performed by total vaginal hysterectomy (TVH); 177(34%) by Laparoscopic-assisted vaginal hysterectomy (LAVH) and 28 (5%) by total laparoscopic hysterectomy / laparoscopic hysterectomy (TLH/LH). For further analysis, the study was divided into two periods. In first period (from Oct.1996 to Dec. 2000), the percentages for patients who underwent TVH and LAVH were 81% and 19% respectively. In second period (from 1/2001 to 4/2005), the percentages for that were 35% and 65%, respectively. The outcomes for three types MIS were analyzed. [Results] The most common indications for three groups were Fibroid, adenomyosis and CIN III. The shorter operation time and less average amount of blood loss were observed in TVH group than that in the LAVH and TLH/LH groups. The advantages of MIS of hysterectomy are less pain, quick recovery and shorter hospital stay. In addition, the marked advantages for laparoscopic group are more clear view for pelvic anatomy, safer for patients with pelvic adhesion and much easier for adnexectomy. Operation time in the first period was longer than second period (93.69 min vs. 67.69 min for TVH; 131.5 min vs. 109 min for LAVH). There was no significant difference of complications for these three groups. [Conclusion] Three types of MIS procedure have their distinctive advantages. For all MIS of total hysterectomy, the operative duration, the amount of blood lost and the complications were tied up with the skills of surgeon, instrumentations, size of uterus and presence of pelvic adhesion. To make a right decision for the patient who has the indication for hysterectomy, the surgeon should comprehensively consider the advantages and disadvantages of various types of MIS, instrument, doctor′s skills as well as patient′s condition.