Laparoscopic-assisted Doderlein hysterectomy: retrospective analysis of 300 consecutive cases

Hysterectomy

Hysterectomy is one of the most commonly performed major surgical procedures; approximately 100,000 are performed in the UK each year. Hysterectomy can be total or subtotal. The postulated benefits of subtotal hysterectomy--better pelvic floor and sexual function--have not been confirmed in randomised trials. Traditionally, hysterectomy was performed using either an abdominal or vaginal approach. More recently, laparoscopic techniques have been used. The decision about the technique used is often related to the surgeon's training and expertise, as the indications for each technique overlap. Vaginal hysterectomy is probably the preferred route because it is quicker and cheaper than laparoscopic hysterectomy, with no other clear differences in outcome measures. Laparoscopic hysterectomy has a number of advantages over abdominal hysterectomy: specifically, shorter hospital stay and quicker return to normal activities; complication rates, however, appear to be greater. This also seems to be the case with radical hysterectomy performed for cervical cancer.

Prospective Evaluation of the Learning Curve of Laparoscopic-Assisted Vaginal Hysterectomy in a University Hospital

STUDY OBJECTIVE

To prospectively analyze the learning curve of laparoscopic-assisted vaginal hysterectomy (LAVH) in a surgical team and evaluate if length of surgery can be reduced safely.

DESIGN

Prospective observational study (Canadian Task Force classification II-2).

SETTING

Department of obstetrics and gynecology in a university-affiliated hospital.

PATIENTS

One hundred and sixty consecutive women undergoing LAVH performed between January 1, 1998 and April 30, 2001.

INTERVENTION

LAVH (AAGL Classification System for Laparoscopic Hysterectomy III-B-3).

MEASUREMENTS AND MAIN RESULTS

The primary parameter evaluated was length of surgery. Patients were grouped in cohorts of 10, in order to perform a time curve that would assist us in evaluation of the learning process. Once the plateau was reached, we evaluated the process before and after this plateau (groups 1 [learning stage] and 2 [second stage], respectively). Average length of surgery was 126 minutes (range, 60-260). Length of surgery was 138 minutes (range, 75-260) in the learning stage (first 80 cases) and 112 minutes (range, 60-225) in the second stage (p <.0001). Total rate of complications was 11.6%. There were three major complications, and they occurred before the plateau. There were 15 minor complications (9.67%), 8 during the first stage and 7 in the second stage, (p =.9; NS). A second learning curve excluding LAVH with associated surgeries was obtained. The average length of surgery for the first stage was 133 minutes (range, 75-205) and 102 minutes for the second stage (range, 60-130) (p >.0001).

CONCLUSION

Analysis of the learning curve demonstrated that the length of surgery in LAVH could be reduced without increasing the number of complications.

Laparoscopic assisted Doderlein hysterectomy: initial experience in a provincial Australian centre

Despite the theoretical advantages that laparoscopic hysterectomy techniques offer, this is not a commonly performed operation in Australia. The laparoscopically assisted Doderlein hysterectomy is a technique that offers significant advantages in speed, ease of performance, and low cost. We describe our technique and results of the first 36 cases performed for a range of clinical indications and uterine weights, using widely available and non-disposable equipment. Operating time (including adjunctive operations) varied from 48 to 165 minutes and no significant complications were encountered.