Comparison of total laparoscopic, vaginal and abdominal hysterectomy

Introduction Due to technical improvements and growing experience, hysterectomies are performed laparoscopically more and more frequently. We analyzed 43 total laparoscopic hysterectomies (TLH) of the years 2005 and 2006 and compared them with 87 vaginal (VH) and 103 abdominal hysterectomies (AH). Methods Patients' original files and surgery reports of the TLHs, VHs and AHs were analyzed retrospectively for the indication of surgery, patients' age, weight, parity, time for surgery, uterus weight, blood loss, post-operative need of analgetics, hospital stay, complications and so on. Data were compared with Student's t test and chi(2) test. Results Indications for TLH were fibroids (n = 21), endometrial cancer (n = 10), bleeding anomalies (n = 7), dysplasia of the cervix uteri (n = 3) and others. In 23/43 cases salpingo-ovarectomy was added, in six cases laparoscopic pelvic or paraaortic lymphadenectomy (LNE) was performed. Looking at cases without LNE, patients' median age was 46 years (32-72), median weight 68 kg (53-115), median time for TLH 130 min (75-270), median uterus weight 150 g (44-954), median blood loss 200 ml (50-600), post-operative analgetica were given for 1.5 days (0-12), and post-operative hospital stay was 6 days (2-15). Indications for VH were genital prolapse (n = 53, 61%), often combined with fixative procedures (n = 50). In this group, median age was significantly higher (median 56 years, P < 0.001). VH was the fastest (median 90 min, P < 0.001), but blood loss was highest (median 300 ml, P = 0.07). In cases with AH, uterus weight was significantly higher (median 290 g, P < 0.001), as well as the need for analgetics (median 4 days, P = 0.001), and the hospital stay was longest (median 8 days, P < 0.001). Major complications of TLH were bladder injury (3x), of VH rectum lesion (2x, both at pelvic repair measures), of AH post-operative ileus (2x) and vesico-vaginal fistula (1x). Conclusion For many patients TLH is a safe and less invasive alternative, especially towards AH, and shows significantly better post-operative reconstitution. Although VH is faster and shows comparable post-operative results, TLH offers the advantage to view the intra-abdominal situs and perform additional steps in case of pathologies.