Hysterectomy for Large Sized Uteri with Benign Pathology: Total Laparoscopic or Vaginal Hysterectomy Using Blood Vessel Sealing Systems? Analysis of 514 Patients

Objective: The goal of this researchwas to compare surgical outcomes of vaginal hysterectomy(VH), using a bipolar vessel sealing system(BVSS; Ligasure,(R) Valleylab, Boulder, CO), with total laparoscopic hysterectomy (TLH) for patients with large uteri. Materials and Methods: Design: This was a dual-center, retrospective analysis (Canadian Task- force Classification II -3) that took place in two tertiary-care hospitals. Patients: Reviews were performed on hospital records ofwomenwith large uteri (uterine weight >= 500 g) who underwent VH or TLH for benign indications between the years 2003 and 2011. Evaluations were conducted on a total of 1988 VH cases, using BVSS, performed in the Minimally Invasive Gynecological Surgery Unit of Valdese Hospital, in Turin, Italy, and 1529 TLH cases, in the department of Obstetrics and Gynecology of the Sacred Heart Hospital, in Negrar, Italy. Data for patients' demographics, indications for surgery, patient histories with respect to previous surgeries, duration of surgeries, blood loss, perioperative complications, and length of in-patient stays were collected from the medical records. Exclusion criteria were: coexistence of uterine, cervical, or ovarian malignancy; uterine-vaginal prolapse; reconstructive pelvic surgery; and associated or other concurrent procedures. Intervention: The intervention analyzed was VH using a Ligasure BVSS and TLH. Results: The two groups were homogenous with respect to demographic data and indications for surgery. The groups were significantly different for mean operative time (VH: 74.7 +/- 34 versus TLH: 139.4 +/- 57 minutes; p < 0.005); mean hospital stay (VH: 1.5 +/- 1.1 versus TLH: 2.8 +/- 1.6 days; p < 0.05); mean blood loss (TLH: 184.6 +/- 211.3mL versus VH: 478 +/- 627.4 mL; p < 0.005). The overall complication rates were 16.25% in the VH versus 10.61% in the TLH group (p = 0.003). Conclusions: In expert hands, both techniques seem to be feasible and relatively safe for enlarged uteri. VH using BVSS results in reduced operative time and hospital stay. Total laparoscopic hysterectomy results in lower blood loss and a lower incidence of perioperative complications, compared with VH, using BVSS.