Gynécologie & Obstétrique
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Introduction of Total Laparoscopic Hysterectomy as a Substitute for Laparoscopically Assisted Vaginal Hysterectomy: A Comparison of the First 23 Cases

Eiji Koike, Yasushi Kotani, Takako Tobiume, Isao Tsuji, Hidekatsu Nakai, Masayo Ukita, Ayako Suzuki, Masahiko Umemoto, Mitsuru Shiota and Masaki Mandai

There are two major procedures in simple laparoscopic hysterectomy, namely laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH). There are not so many reports in which LAVH and TLH have been compared directly. In our facility, LAVH had also been performed routinely for benign lesions. Recently, we have been attempting to introduce TLH to substitute LAVH. To examine whether introduction of TLH in a facility in which LAVH has been predominantly performed has any specific risks, the first 23 cases were retrospectively compared with LAVH procedures performed in the past. A total of 246 cases of LAVH performed in our facility from January 2007 to June 2013 were retrospectively compared with first 23 cases of TLH. The operative time was significantly longer in the TLH group. The estimated blood loss during surgery was also significantly lower in TLH group. Four cases required blood transfusions in the LAVH group, while no cases needed blood transfusions in the TLH group. Complications related to surgery occurred in 12 cases in the LAVH group: 3 cases of peritonitis, 2 cases of vaginal cuff bleeding, 3 cases of vaginal cuff abscess, 1 case of pulmonary thrombosis, 1 case of vesico-vaginal fistula, 1 case of ureteral injury and 1 case of intestinal herniation at port site. There were no complications in the TLH group. The length of hospital stay was not significantly different. As a conclusion, although there was significant bias in the case selection, it is feasible to introduce TLH safely in a facility which has sufficient experience of LAVH.