Establishment of Total Laparoscopic Hysterectomy (TLH) in a University Gynecology Department: Results of the First 100 Operations

Zusammenfassung

Fragestellung: Die totale laparoskopische Hysterektomie (TLH) wird im Gegensatz zu den etablierten Operationsmethoden bisher wenig beachtet. Allgemein wird den laparoskopischen Techniken eine höhere Komplikationsrate verglichen mit den abdominellen und vaginalen Operationstechniken nachgesagt. Wir berichten über unsere Erfahrungen und Ergebnisse der ersten 103 Operationen bei der Einführung der TLH unter Verwendung des „Hohl-Manipulators“ im Routinebetrieb an einer universitären Ausbildungsklinik. Patientinnen und Methoden: Zwischen Mai 2004 und Februar 2006 wurden 103 Patientinnen an der Universitätsfrauenklinik Erlangen laparoskopisch hysterektomiert. Ausgewertet wurden die Operationsdauer, das Uterusgewicht, der operationsbedingte Blutverlust sowie intra- und postoperative Komplikationen. Ergebnisse: Keinerlei Blasen-, Ureter-, Gefäß-, Darmläsion oder Bluttransfusion wurden beobachtet. Intraoperativ wurde einmal zur Laparotomie konvertiert. Die mittlere Operationszeit betrug 115,1 ± 32,1 Minuten, das mittlere Uterusgewicht betrug 248,9 ± 134,9 g und die mittlere Hämoglobinveränderung 1,6 ± 0,9 g/dL. Postoperativ trat zwei Komplikationen auf. Schlussfolgerung: Die Verwendung des „Hohl-Manipulators“ vereinfacht die TLH. Die intraoperative Komplikationsrate scheint bei entsprechender Erfahrung des Operateurs niedrig zu sein. Die TLH stellt eine Alternative zu den bisherigen Operationsmethoden dar.

Abstract

Background: In contrast to the established surgical methods, total laparoscopic hysterectomy (TLH) has so far attracted little attention. Laparoscopic techniques are generally thought to be associated with a higher complication rate compared with abdominal and vaginal surgical techniques. We report here on our experience and on the results of the first 103 operations after the introduction of TLH with the use of a “Hohl manipulator” into routine practice at a university teaching hospital. Methods: Between May 2004 and February 2006, 103 patients underwent laparoscopic hysterectomy at the Dept. of Gynecology in Erlangen. Data evaluated included the operating time, uterine weight, surgery-related blood loss, and intraoperative and postoperative complications. Results: No injuries to the bladder, ureter, vessels, or intestine were observed, and no blood transfusions were required. The mean operating time was 115.1 ± 32.1 min, the mean uterine weight was 248.9 ± 134.9 g, and the mean hemoglobin change was 1.6 ± 0.9 g/dL. Two postoperative complications occurred. Conclusions: The use of the Hohl manipulator simplifies the TLH procedure. When the surgeon is sufficiently experienced, the intraoperative complication rate appears to be low. TLH represents an alternative to previous surgical methods.

Totale laparoskopische Hysterektomie (TLH) - Komplikationsrate - Sicherheit - Durchführbarkeit

Total laparoscopic hysterectomy (TLH) - complication rate - safety - feasibility

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