helios kliniken gmbh b.stitz, helios st. elisabeth klinik hünfeld comparison of laparoscopic and...

HELIOS Kliniken GmbH

B.Stitz, HELIOS St. Elisabeth Klinik HünfeldHELIOS Kliniken GmbH

Comparison of Laparoscopic and Open Hysterectomy

B. Stitz MD

HELIOS St. Elisabeth Klinik Hünfeld


The Purpose of the Study

to evaluate the procedure and the outcome of transvaginal, abdominal and laparoscopic hysterectomy

• duration of the operation and anaesthesia

• size of the uterus

• blood loss

• duration of hospitalisation

• complications


Preoperative Evaluation

• Evaluation of dysfunctional uterine bleeding, pelvic pain, dysmenorrhoe, urinary frequency, incontinence, parity status

• Inspection (pelvic floor deficiency, vaginal prolapse)

• Palpation (size and mobility of the uterus, additional findings at ovaries and tubes, peritoneal adhesions after laparotomy and redo operations)

• Sonography transvaginal and abdominal


Patient Inclusion Criteria

• Only patients treated with hysterectomy with/without salpingooophorectomy and/or McCall‘s suture were included.

• Neither reconstruction of the pelvic floor (open or laparoscopic approach) nor incontinence procedures, adhesiolysis nor any other simultaneous operations were allowed, no patients with alloplastic implants were included.

• N = 232


Operation Techniques

• Wertheim clamps and sutures

• transvaginal or abdominal removal of the uterus

• complete closure of the vagina

• no complete suture of the peritoneum parietale

• one 10mm and two 5mm trocars

• ultrasound tissue dissection

• transvaginal extraction of the uterus

• complete closure of the vagina and of the peritoneum parietale from the inside

identical material and needles for sutures in all approaches

transvaginal or abdominal laparoscopic


Weight of the Removed Uterus

0

200

400

600

800

1000

1200

1400

1600

1800

2000

g

abdominal vaginal laparoscopic

minimum

average

maximum


Laparoscopic Hysterectomy Sept. 7th, 2004

Uterus 1911g

laparoscopic approach


Duration of Operations

0

50

100

150

200

250

min.


minimum

average

maximum


Haemoglobin before/after Operation

0

5

10

15


after (g/dl)

before (g/dl)

after (g/dl) before (g/dl)


Blood Loss Perioperative

-1

0

1

2

3

4

5

6

7

8

g/dl


minimum

average

maximum


Duration of Hospitalisation

0

2

4

6

8

10

12


days


Results

• As expected uteri removed by vaginal approach were significantly smaller than those removed laparoscopically or by laparotomy.

• Blood loss showed no significant difference between vaginal and laparoscopic operation. It was, however, significantly lower than in abdominal approach.

• Abdominal and laparoscopic procedures took more time than transvaginal operations.

• Patients with laparoscopic operations were discharged earlier than those with vaginal hysterectomies. After abdominal operations patients needed twice the time to recover and for being discharged.

• There was no significant difference in intra- and postoperative complications between the different approaches.


Conclusions

• Laparoscopic hysterectomy is a safe, fast and comfortable technique.

• Laparoscopic hysterectomy can particularly be recommended to replace most laparotomies done to remove even the large and heavy uterus.

• For smaller uteri we found no advantage in comparison to the vaginal approach.

• In our hospital almost 50% each of all hysterectomies following the described criteria in 2005 were performed by using vaginal and laparoscopic approach respectively. Only one laparotomy (0,55%) was needed.

helios kliniken gmbh b.stitz, helios st. elisabeth klinik hünfeld comparison of laparoscopic and...

Documents

helios kliniken gmbh

stitz md helios

elisabeth klinik hnfeld

elisabeth klinik hnfeld

abdominal slide

removed uterus slide

laparoscopic operations

abdominallaparoscopic