Clinical Trial of Total Laparoscopic Hysterecomy: Initial Result

Kim, Dae Geun; Park, Il Soo; Lee, Yoon Soon

Abstract

Owing to rapid development of laparoscopic thechnique and equipment, even to laparoscopic radical hysteretomy was possible. The objectives of this study were to evaluate the feasibilltiy, and operative and postoperative outcomes fo our intial experience of total laparoscopic hysteretomy(TLH) at the Department of Obstetrics nad gynecology, Kyong Pook National Unviersity Hospital from April 1995 to July 1995.20 cases were completely performed by laparoscopy(80%). 5case were conveted to vaginal procedure (20%) due to bleeidng and difficulty in dissection of parametrial tissue.None of these patient had laparotomy. The mean age of the patients was 46.6 +/- 6.2 years old. The most common indication was myoma (50%). Other indications were adenomyosis (25%), myoma with adenomyosis(15%), adenomysis with endometriosis(5%) and endometrial carcinoma(5%). The mean operative time was 148.0 +/- 51.0(100~245)minutes, the mean estimated blood loss was 99.9 +/- 84.9(20~350)ml, the mean uterine weight was 312.1 +/- 110.2(105~570)gm, and the mean hospital stay was 5.1 +/- 1.7(3~11) DAY. The complications of TLH were 2cases of vaginal cuff infection, and 4 transfusions due to anemia and blood loss during operation. The most common combined operation was bilateral salpingoophorectomy. Out sutdy suggested that even large sized myoma up to 570mg can be removed by laparoscopy without delayed bleeding. Even the technique of TLH was difficult and only performed by an experienced laparoscopic pelvic surgeon in the selected cases, but we had experience of many advatages by use of vaginal tube, such as avoiding ureter injury, reducing volume of parametrium and reducing gas loss during laparoscopic suturing. It is clear that not all patients requiring hysterectomuy will benefit from total laparoscopeic hysterectomy but some patients who were dificult for vaginal hysterectomy beacse of narrow and atrophic vagina and poor uterine mobility may have some benefits from TLH.