Total laparoscopic hysterectomy: a 5-year experience

AimTo 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.MethodsRetrospective study based on TLH operations performed from January 2001 to December 2005. The KOH Colpotomizer™ System and the RUMI Uterine Manipulator® were used.ResultsFive 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 ≥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.ConclusionTLH with adequate training is associated with low morbidity, few complications and a high success rate.