Complication Rate of Laparoscopic Hysterectomies in Denmark, 2011-2016

A Comparison between Total Abdominal Hysterectomy versus Total Laparoscopic Hysterectomy

Objectives

To compare the operative and postoperative outcomes of total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH).

Materials and Methods

In this retrospective comparative study, we reviewed all hysterectomies performed in the Al-Karak Governmental Hospital in Al-Karak, Jordan, from September 2018 to July 2022. We enrolled 129 patients who underwent hysterectomy. The patients were divided into the TLH (n = 39) and TAH (n = 90) groups. Patient data were accessed through hospital records and analyzed using SPSS 25.0.

Results

The most common indication for TLH was uterine fibroid, and that for TAH was abnormal uterine bleeding, although the specimen weights were comparable. There was no significant between-group difference in the patient's demographics. Although the TLH group had longer operative time, the hospital stay was shorter and there were no reported cases of wound infection. The estimated blood loss was significantly lower in the TLH group than in the TAH group, but there was no difference between the two groups in terms of blood transfusion requirement and postoperative hemoglobin level.

Conclusion

TLH and TAH had comparable overall outcomes in the Al-Karak Governmental Hospital. However, TLH was superior to TAH in terms of blood loss, and patients with TLH recovered faster without postoperative wound infection.

Implementation of Total Laparoscopic Hysterectomy As the Default Technique and Lessons Learnt

Introduction Concerns about surgical complications and the paucity of surgical audits have been named as reasons for the slow implementation of total laparoscopic hysterectomy (TLH) in New Zealand and Australia, despite a majority of gynaecologists who would like to offer this less-invasive approach to their patients. Material and methods This study aims to assess the implementation of TLH as the default method of hysterectomy at a private institution in the Waikato region of New Zealand, and to identify factors related to the perioperative complications and to the failure to accomplish the above procedure laparoscopically in an unselected population. We present 1,287 cases collected over fourteen years with an emphasis on demographics, outcomes, indications for surgery, laparoscopic completion of the surgical procedure and perioperative major complications. Results One hundred and fifty patients (11.7%) were nulliparous and 378 patients (29.4%) had a history of the previous laparotomy. The mean theatre time and SD was 144.84 ± 20.48 min; the mean blood loss was 137.24 ± 69 mL; the mean hospital stay was 2.07 ± 0.31 days; the median uterine weight was 177 g and the biggest uterus removed laparoscopically weighed 1,510 g. Twelve cases were converted to laparotomy (0.93%). The uterine weight had a statistically significant association with the conversion rate. The main indications for surgery were menorrhagia and/or recurrent dysmenorrhoea in 662 patients (51.4%) and fibroid uterus in 228 patients (17.7%). Six patients (0.47%) required blood transfusions. There was a total of 74 perioperative complications (5.7%) and 16 major complications (1.24%). BMI and uterine weight had a statistically significant association with major complication rates. Seven patients (0.54%) were re-operated as a result of a complication. Conclusion The implementation of TLH as default is achievable and is a safe surgical option. BMI and uterine weight are factors associated significantly with major complications or conversion to laparotomy.

Comparison of Total Laparoscopic Hysterectomy with Abdominal Total Hysterectomy in Patients with Benign Disease: A Retrospective Cohort Study

Background

The present study aimed to determine whether total laparoscopic hysterectomy (TLH) is being implemented safely and appropriately compared with abdominal total hysterectomy (ATH) in our hospital.

Methods

We retrospectively reviewed clinical records of 102 patients who underwent total hysterectomy for benign gynecological disease at Japanese Red Cross Yamaguchi Hospital from January 2017 to August 2018. We examined periods of hospital stay, operation time, blood loss, weight of the uterus, frequency of perioperative complications, and the duration from the first visit to the date of surgery. P < 0.05 was considered to be statistically significant indicated statistical significance.

Results

TLH and ATH were performed in 55 (53%) and 47 (46%) cases, respectively. The TLH group had significantly longer total operation time [133 (82-205) min vs. 87 (57-155) min, P < 0.0001], lesser blood loss [5 (5-35) g vs. 100 (10-820) g, P < 0.0001], shorter hospital stay [7 (5-14) days vs. 10 (9-26) days, P < 0.0001], and lighter uterine weight [206 (27-658) g vs. 554 (79-2284) g, P < 0.0001] than the ATH group. The frequency of perioperative complications did not differ between the two groups (3.5% vs. 8.0%, P = 0.4103).

Conclusion

TLH had a longer operation time and a lesser excised uterine weight, but it had less intraoperative blood loss, shorter hospital stay, and no difference in perioperative complication frequency when compared with ATH.

Training in the Departments of Urology and Surgery for Gynecologists in Japan

Background

The authors wanted to understand the current situation concerning Japanese obstetricians' and gynecologists' ideas for and against training in other departments.

Methods

We sent questionnaires to obstetrics and gynecology (Ob-Gyn) specialists via a social networking service (SNS) in Japan. They answered anonymously using Google Forms over the internet.

Results

The respondents comprised 120 Ob-Gyn specialists, and their age ranges of 28-29, 30-39, 40-49, and 50 or more, were 5.8%, 73.3%, 15.8%, and 5.0%, respectively. Only five Ob-Gyn specialists (4.2%) had experience in other departments, specifically gastrointestinal and urology. Ninety percent of them responded that they thought training in other departments was useful for developing clinical and surgical skills. In addition, 91.0% of respondents thought that surgical knowledge and skills were necessary in the clinical practice of gynecology, while 94% stated training in urology was also necessary. However, 49.2% of respondents answered that they may feel stress training in other departments where there were many issues, including a lack of personnel and difficulties securing cases.

Conclusion

Many Ob-Gyn specialists think training in other departments is necessary, but potential problems include proper training implementation and stress management for residents. If additional training is enforced, greater flexibility in each facility will be required.

Gynecologists May Underestimate the Amount of Blood Loss during Total Laparoscopic Hysterectomy

Background

We considered the possibility of underestimation of the amount of bleeding during laparoscopic surgery, and we investigated comparing the amount of bleeding between laparoscopic surgery and open surgery by considering the concentration of hemoglobin before and after surgery as indicators.

Methods

The following procedures were included: A, surgery for ovarian tumor; B, myomectomy; and C, hysterectomy either by laparoscopic surgery or open surgery. Patients who underwent the above procedures in between January 1, 2010, and December 31, 2017, were enrolled. We identified 1749 cases (A: 90, B: 105, and C: 325 of open surgery and A: 667, B: 437, and C: 125 of laparoscopic surgery). We considered the sum as an estimation of blood loss during surgery and the change in the value of hemoglobin in laboratory testing one day before and after surgery.

Results

During laparoscopic surgery, the measurements of blood loss included the following: A: 59.8 ml; B: 168.6 ml; and C: 206.8 ml. During open surgery, measurements of blood loss included the following: A: 130.7 ml; B: 236.7 ml; and C; 280.9 ml. The reduction of hemoglobin after surgery compared with that before surgery was less in laparoscopic surgery than that in open surgery in A and B; however, this reduction was not significantly different in C.

Conclusion

Our results suggest that the estimation of the bleeding in A and B was appropriate; however, the estimation might be underestimated in C during laparoscopic surgery.