Current Restricted or Conservative Approach to Laparoscopic Hysterectomy at a German University Department of Gynecology and Obstetrics

Abstract

Background and objectives: Laparoscopic hysterectomy, although still in small numbers compared to abdominal and vaginal hysterectomy, is performed worldwide. Most gynecologists believe that it is a safe procedure and that patients experience less postoperative pain, a shorter hospital stay and more satisfaction than after conventional abdominal hysterectomy. Laparoscopic hysterectomy, in any of its multiple forms, aims to replace laparotomic hysterectomy and facilitates more vaginal hysterectomies with the additional possibility of screening and curing abdominal abnormalities. However, there is still little acceptance of this relatively new method of hysterectomy. Methods: We retrospectively reviewed hysterectomies performed over a five-year period (1998-2002) at the Department of Obstetrics and Gynecology, University of Kiel, Germany. A comparison was drawn between successful laparoscopic surgery and cases which had to convert to abdominal hysterectomy. Ten doctors, only one of whom was a keen laparoscopist with respect to hysterectomies, were involved in the decision-making process on the type of hysterectomy to be performed. Results: Of 2 313 hysterectomy procedures carried out over a five-year period for benign alterations of the uterus, the laparoscopic approach was performed in only 45 cases. Abdominal hysterectomy was carried out in 1 108 cases (48 %) and vaginal hysterectomy in 1 159 cases (50 %). The most common indication for laparoscopic surgery was uterine fibroid. In six cases (13.33 %) a conversion to abdominal hysterectomy was necessary. Marked adhesions in the pelvis was the most important factor for failure of laparoscopic surgery. Conclusion: Laparoscopic hysterectomy still has limitations and laparoscopists have to be aware of difficulties approaching the pelvis especially in patients with a previous history of pelvic surgery. In our department between 1998 and 2002 very few indications for laparoscopic hysterectomies in benign cases were found. However, patients should be clearly informed about the benefits and risks of laparoscopic hysterectomy and be involved in the decision-making process.

Key words

Laparoscopy - hysterectomy

References

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