Risks and Benefits of Total Laparoscopic Hysterectomy and the Effect of Learning Curve on Them

STUDY OBJECTIVE: The objective of this study was to prospectively analyze the risks and benefits of total laparoscopic hysterectomy (TLH) compared with total abdominal hysterectomy (TAH) and the effects of learning curve on them over 4 years (March 2010-April 2014). DESIGN: It was a prospective randomized study. SETTING: The study was conducted in Delhi government hospital which had no staff with previous experience of advanced laparoscopic surgeries. PATIENTS: Two hundred fifty patients were operated on for benign gynecological conditions (35-65 years). The numbers of cases operated laparoscopically were as follows-22 in 2010, 25 in 2011, 32 in 2012, and 46 in 2013. Equal number. of patients operated by open surgery were taken in the study during the same time period. RESULTS: Two hundred fifty cases were operated since March 2010, by either laparoscopic or open surgery. Incidence of major complications was-1.6 % for TLH compared to 4 % in TAH. After the first year of surgery, this incidence has fallen to 0 % in subsequent years in TLH group. The incidence of minor complications declined from 14 to 4.5 % in the third year of study. Total rate of conversion to laparotomy was 9.7 %, which again had a significant decline after the first year. TLH also clearly showed superior benefits of less intraoperative blood loss, early postoperative ambulance, and shorter period of hospital stay in comparison with TAH. CONCLUSION: The study has led us to conclude that TLH is a safe, effective, and reproducible technique after the completion of a period of training necessary to standardize the procedure. This approach must be established in our real, day-to-day clinical practice.