Laparoscopic supracervical hysterectomy (LSH) versus total laparoscopic hysterectomy (TLH): an implementation study in 1
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GENERAL GYNECOLOGY
Laparoscopic supracervical hysterectomy (LSH) versus total laparoscopic hysterectomy (TLH): an implementation study in 1,952 patients with an analysis of risk factors for conversion to laparotomy and complications, and of procedure-specific re-operations Markus Wallwiener • Florin-Andrei Taran • Ralf Rothmund • Adam Kasperkowiak Gabriel Auwa¨rter • Antje Ganz • Bernhard Kraemer • Harald Abele • Birgitt Scho¨nfisch • Keith B. Isaacson • Sara Yvonne Brucker
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Received: 30 October 2012 / Accepted: 2 May 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Purpose To compare laparoscopic supracervical hysterectomy (LSH) with total laparoscopic hysterectomy (TLH) with regard to relevant surgical parameters and risk factors of conversion to laparotomy and complications. Methods This prospective, open, single-center, interventional study included women with benign gynecologic disease who underwent standardized LSH or TLH. The techniques were compared for conversion rate and mean operating time, hemoglobin drop, hospital stay, and complication rates using descriptive statistics and standard nonparametric statistical tests. Risk factors of conversion and complications were identified by logistic regression analysis. Results During January 2003 to December 2010, 1,952 women [mean age (SD): 47.5 (7.2) years] underwent LSH [1,658 (84.9 %)] or TLH [294 (15.1 %)], mostly ([70 %) for uterine fibroids. Significant differences in surgical parameters were observed for conversion rate (LSH/TLH: 2.6/6.5 %), mean operating time [87 (34)/103 (36) min], M. Wallwiener (&) Department of Obstetrics and Gynecology, University of Heidelberg, Voßstraße 9, 69115 Heidelberg, Germany e-mail: [email protected] F.-A. Taran R. Rothmund A. Kasperkowiak G. Auwa¨rter A. Ganz B. Kraemer H. Abele B. Scho¨nfisch S. Y. Brucker Department of Obstetrics and Gynecology, University of Tu¨bingen, Calwerstraße 7, 72076 Tu¨bingen, Germany K. B. Isaacson Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, 2014 Washington Street, Newton, MA 02462, USA
hemoglobin drop [1.3 (0.8)/1.6 (1.0) g/dL], and hospital stay [4.3 (1.5)/4.9 (2.8) days]. Overall intraoperative (0.2/ 0.7 %) and long-term ([6 weeks) post-operative (0.8/ 1.7 %) complication rates did not differ significantly, but the short-term LSH complication rate was significantly lower (0.6 vs. 4.8 %). Spotting (LSH, 0.2 %) and vaginal cuff dehiscence (TLH, 0.7 %) were long-term methodspecific complications. Logistic regression showed that uterine weight and extensive adhesiolysis were significant factors for conversion while previous surgery, age, and BMI were not. Major risk factors of short-term complications were age, procedure (LSH/TLH), and extensive adhesions. Conclusions Both procedures proved effective and were well tolerated. LSH performed better than TLH regarding most outcome measures. LSH is associated with very low rates of re-operation and spotting. Keywords Hysterectomy Laparoscopy LASH Benign gynecolo
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