Total laparoscopic hysterectomy: A 10-year experience of our clinic

Abstract

This study aimed to evaluate the clinical outcomes, advantages, and limitations of total laparoscopic hysterectomy (TLH), and to retrospectively analyze TLH cases performed in our clinic in the context of current literature. A total of 789 patients who underwent TLH for benign or malignant gynecological indications between January 2015 and January 2025 were retrospectively analyzed. Demographic characteristics, surgical indications, operative time, intraoperative and postoperative complications, length of hospital stay, and histopathological findings were recorded. Complications were classified according to the Clavien–Dindo classification system. The mean age of the patients was 49.51 ± 7.74 years. The most common indications were abnormal uterine bleeding (36.25%) and adenomyosis (25.86%). A history of previous abdominal surgery was present in 56.15% of patients. The mean operative time was 82.32 ± 39.98 minutes, and the mean length of hospital stay was 56.62 ± 14.22 hours. The intraoperative complication rate was 0.38%, while the postoperative complication rate was 17.11%, with the majority being minor complications. Total laparoscopic hysterectomy is a safe and effective surgical approach associated with favorable perioperative outcomes. Increased surgical experience appears to be associated with reduced complication rates. Our findings support TLH as a preferred minimally invasive technique in appropriately selected patients.

Keywords

• Laparoscopy
• safe surgery
• experience
• hysterectomy

References

1. Djokovic D, Noé G, Van Herendael BJ, Chrysostomou A. The routes of hysterectomy: A survey of current practices amongst members of the International Society for Gynaecologic Endoscopy (ISGE). Eur J Obstet Gynecol Reprod Biol. 2023; 291:99-105.
2. Reich H, DeCaprio J, McGlynn F. Laparoscopic hysterectomy. J Gynecol Surg 1989; 5:213-6
3. Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy rates in the United States, 2003. Obstet Gynecol 2007; 100:1091-5.
4. Whiteman MK, Hillis SD, Jamieson DJ, Morrow B, Podgornik MN, Brett KM, et al. Inpatient hysterectomy surveillance in the United States, 2000–2004. Am J Obstet Gynecol. 2008; 198(1):34 e1–7.
5. Falcone T, Walters MD. Hysterectomy for benign disease. Obstet Gynecol. 2008; 111:753–767.
6. Cohen SL, Vitonis AF, Einarsson JI. Updated hysterectomy surveillance associated with and minimally hysterectomy. JSLS. 2014; factors invasive 18(3).
7. Miskry T, Magos A. Randomized, prospective, double-blind comparison of abdominal and vaginal hysterectomy in women without uterovaginal prolapse. Acta Obstet Gynecol Scand. 2003; 82:351–358 (Class I).
8. Sesti F, Ruggeri V, Pietropolli A, Piccione E. Laparoscopically assisted vaginal hysterectomy versus vaginal hysterectomy for enlarged uterus. JSLS. 2008; 12:246–251 (Class I).

9. Moen MD, Richter HE. Vaginal hysterectomy: past, present, and future. Int Urogynecol J. 2014; 25(9):1161–5.
10. AAGL Position Statement. Route of hysterectomy to treat benign uterine disease. J Minim Invasive Gynecol 2011; 18:1-3.
11. ACOG Committee Opinion 444.Choosing the route of hysterectomy for benign disease. Obstet Gynecol 2009; 144:1156-8.
12. Garry R, Fountain J, Mason S, Hawe J, Napp V, Abbott J, et al. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ. 2004; 328:129 (Class I).
13. Sokol AI, Green IC. Laparoscopic hysterectomy. Clin Obstet Gynecol.2009.; 52(3), 304–312.
14. Candiani M, Izzo S, Bulfoni A, Riparini J, Ronzoni S, Marconi A. Laparoscopic vs vaginal hysterectomy for benign pathology. Am J Obstet Gynecol. 2009; 200(4):368 e1–7.
15. Elkington, N. M., & Chou, D. A review of total laparoscopic hysterectomy: role, techniques and complications. Current Opinion in Obstetrics and Gynecology, 2006; 18(4), 380–384.
16. Reich H, McGlynn F, Sekel L. Total laparoscopic hysterectomy. Gynaecol Endosc 1993; 2:59–63
17. Reich H. Laparoscopic hysterectomy. Surg Laparosc Endosc.1992; 2(1):85-8.
18. Walsh CA, Walsh SR, Tang TY, Slack M. Total abdominal hysterectomy versus total laparoscopic hysterectomy for benign disease: a meta-analysis. Eur J Obstet Gynecol 2009; 144:3-7.
19. Johnson N, Barlow D, Lethaby A, Tavender E, Curr E, Garry R. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2006; 19(2)CD003677.
20. Reich H. Total laparoscopic hysterectomy: indications, techniques and outcomes. Current Opinion in Obstetrics and Gynecology, 2007; 19(4), 337–344.
21. Cario GM, Carlton MA. Total laparoscopic hysterectomy with laparosonic coagulating shears: a retrospective report of 200 consecutive cases. Aust N Z J Obstet Gynaecol. 2001; 41:307–310.
22. Chou DC, Rosen DM, Cario GM, Carlton MA, Lam AM, Chapman M, et al. Home within 24 hours of laparoscopic hysterectomy. Aust N Z J Obstet Gynaecol 1999; 39:234–238.
23. Kluivers KB, Johnson NP, Chien P, Vierhout ME, Bongers M, Mol BW. Comparison of laparoscopic and abdominal hysterectomy in terms of quality of life: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2008; 136(1):3-8.
24. Salman S, Ayanoğlu YT, Bozkurt M, Kumbasar S, Kavşi B, Sertoğlu E, et al. Kliniğimizde yapılan total laparoskopik histerektomi operasyonlarının değerlendirilmesi. JAREM. 2015 ;5(1):10-13.
25. Bonilla DJ, Mains L, Rice J, Crawford B. Total laparoscopic hysterectomy: Our 5-year experience (1998-2002). Ochsner J. 2010; 10(1):8-12.
26. Molloy D, Kaloo PD, Cooper M, Nguyen TV. Laparoscopic entry: a literature review and analysis of techniques and complications of primary port entry. Aust N Z J Obstet Gynaecol. 2002; 42(3):246–54.
27. Ahmad G, Gent D, Henderson D, O’Flynn H, Phillips K, Watson A. Laparoscopic entry techniques. Cochrane Database Syst Rev. 2015; 31(8):CD006583.
28. Demirayak G, Kılık T, Çetinkaya FN, Bulut B, Akbaş M, Kılınç A, et al. Laparoskopik Histerektomi Deneyimlerimiz. Okmeydanı Tıp Dergisi. 2016; 32(4):198-203.
29. Kale A, Aksu S, Terzi H, Demirayak G, Turkay U, Sendag F. Uterine artery ligation at the beginning of total laparoscopic hysterectomy reduces total blood loss and operation duration. J Obstet Gynaecol. 2015; 35(6):612-5
30. Malinowski A, Makowska J, Antosiak B. Total laparoscopic hysterectomy-indications and complications of 158 patients. Ginekol Pol. 2013; 84(4):252-7.
31. Wattiez A, Soriano D, Cohen SB, Nervo P, Canis M, Botchorishvili R, et al. The learning curve of total laparoscopic hysterectomy: comparative analysis of 1647 cases. J Am Assoc Gynecol Laparosc. 2002; 9(3)39-45
32. Leonard F, Chopin N, Borghese B, Fotso A, Foulot H, Coste J, et al. Total laparoscopic hysterectomy: preoperative risk factors for conversion to laparotomy. J Minim Invasive Gynecol. 2005; 12(4):312–317.
33. Morelli M, Caruso M, Noia R, Chiodo D, Cosco C, Lucia E, et al. Total laparoscopic hysterectomy versus vaginal hysterectomy: a prospective randomized trial. [Article in Italian] Minerva Ginecol 2007; 59(2): 99-105.
34. Mäkinen J, Johansson J, Tomás C, Tomás E, Heinonen PK, Laatikainen T, et al. Morbidity of 10110 hysterectomies by type of approach. Hum Reprod. 2001; 16(7):1473-8
35. Fuchs Weizman N, Einarsson JI, Wang KC, Vitonis AF, Cohen SL. Vaginal cuff dehiscence: risk factors and associated morbidities. JSLS 2015;19(2): e2013.00351.
36. Kowalski LD, Seski JC, Timmins PF, Kanbour AI, Kunschner AJ, Kanbour-Shakir A. Vaginal evisceration: presentation and management in postmenopausal women. J Am Coll Surg. 1996; 183(3):225-9.
37. Croak AJ, Gebhart JB, Klingele CJ, Schroeder G, Lee RA, Podratz KC. Characteristics of patients with vaginal rupture and evisceration. Obstet Gynecol. 2004; 103(3):572-6.
38. Yada-Hashimoto N, Onoue M, Yoshimi K, Hisa T, Kodama M, Otsuka H, et al. Total laparoscopic hysterectomy in patients with previous abdominal surgery. Arch Gynecol Obstet 2011; 284(6):1467-71.
39. Thiel J, Gamelin A. Outpatient total laparoscopic hysterectomy. J Am Assoc Gynecol Laparosc. 2003;10(4):481-3
40. Morrison JE, Jacobs VR. Outpatient laparoscopic hysterectomy in a rural ambulatory surgery center. J Am Assoc Gynecol Laparosc. 2004; 11(3):359-64