Total laparoscopic hysterectomy: a 5-year experience.

AIM: To evaluate our surgical technique with regards to the success of total laparoscopic hysterectomy (TLH) for the removal of the uterus by analysing its intra-operative and post-operative outcomes and complications in the hope of reducing their occurrence.

METHODS

Retrospective study based on TLH operations performed from January 2001 to December 2005. The KOH Colpotomizer System and the RUMI Uterine Manipulator were used.

RESULTS

Five hundred and twelve women consented for TLH. Five hundred and three women (98.2%) had successful TLH with three mini-laparotomy and six laparotomy conversions (1.8% failure rate). Mean uterine size was 11 cm (5-17). Mean operating time was 133 min (40-257). Mean blood loss was 309 ml (50-1,500). Twenty patients (4%) required blood transfusion (five excessive bleeding). Injuries include bowel injury (5), bladder (2), uterine perforation (1), ureterovaginal fistula (1) and vaginal laceration (5). Post-operative complications include pyrexia (36), umbilical wound infection (5), urinary tract infection (UTI) (4) and vault haematoma (3). Mean hospital stay was 2.7 days (1-10). Eighteen patients (3.6%) were readmitted for vaginal bleeding (10), vault haematoma (2), UTI (1), anxiety (3), giddiness (1) and ureterovaginal fistula (1). Twenty-three women (4.5%) encountered major complications (laparotomy conversion, excessive bleeding requiring blood transfusion, hemorrhage > or =1,000 ml, ureteric injury, bowel injury and pulmonary embolus) which compares favourably with other centres (4-11%). Our mean operating time, mean estimated blood loss, mean hospital stay and readmission rate are comparable.

CONCLUSION

TLH with adequate training is associated with low morbidity, few complications and a high success rate.