Clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy:: a randomized controlled study

Background. To evaluate clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy. Methods. Fifty women scheduled for abdominal hysterectomy were randomized to undergo either laparoscopic (n=25) or abdominal (n=25) hysterectomy. Surgical characteristics, hospital stay, convalescence and complications were analyzed. Blood samples for assay of markers of tissue trauma (interleukin-6, C-reactive protein, tumor-associated trypsin inhibitor and tumor-associated antigen CA 125) were taken preoperatively, an the first, second and seventh postoperative day and at the follow-up visit four weeks after surgery Results. In uncomplicated hysterectomies (n=18) the operating time (85.3 min versus 57.5 min, p<0.00001) was longer for laparoscopic group but the hospital stay (2.1 days versus 3.4 days, p<0.00001) and sick leave (21.4 days versus 38.5 days, p<0.00001) were shorter in the laparoscopic group. Postoperative increases in all markers were significant in both groups. The interleukin-6 concentration was highest on the first postoperative day in both groups, that of C-reactive protein on the second postoperative day in both groups, tumor-associated trypsin inhibitor on the seventh postoperative day in the laparoscopic group and on the second postoperative day in the abdominal group and tumor-associated antigen CA 125 on the seventh postoperative day in both groups. Both interleukin-6 and C-reactive protein levels were lower in the laparoscopic group on the first (p=0.01 and p=0.03, respectively) and on the second postoperative day (p=0.02 and p<0.001, respectively) compared with the abdominal group. No differences were seen in tumor-associated trypsin inhibitor and tumor-associated antigen CA 125 levels between the groups. Conclusion. Laparoscopic hysterectomy should replace abdominal hysterectomy whenever possible because of a more favorable clinical outcome and less tissue trauma.