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Laparoscopically-assisted vaginal hysterectomy for enlarged uterus: operative outcomes and the learning curve
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Abstract
Objectives: The aim of the study was to compare the effects of uterine size and surgeon experience on the surgical outcomes of laparoscopically-assisted vaginal hysterectomy (LAVH) for benign gynecological conditions.
Material and methods: This was a retrospective analysis of 184 LAVH cases. All hysterectomies were performed by the same surgeon and divided into two groups, with uterine weight of < 280 g (group 1) and uterine weight of > 280 g (group 2). The groups were compared in terms of the effects of the uterine size and surgeon experience vs. the operative outcomes (operative time, change in hemoglobin levels, hospital stay, and perioperative complications).
Results: No significant differences in mean age, parity, history of chronic systemic diseases and previous surgery history were observed between the two groups. However, operative time was significantly greater in group 2 as compared to group 1 (132.1 ± 42.7 minutes vs. 111.5 ± 30.4 minutes, p < 0.05). There were no differences in the hospital stay and perioperative complications between the two groups. One case of bladder injury occurred in each group and one patient underwent a second laparoscopic surgery for postoperative bleeding in group 2. Greater surgeon experience was demonstrated to be associated with decreased operative bleeding and, consequently, smaller differences between preoperative and postoperative hemoglobin levels. Operative time was also reduced as the surgeon was getting more experienced but the effect did not reach statistical significance.
Conclusions: Our study supports the thesis that LAVH is a safe and effective procedure for managing benign gynecological conditions. Despite increased operative time, LAVH can be safely performed for enlarged uterus in conjunction with increased surgeon experience.
Abstract
Objectives: The aim of the study was to compare the effects of uterine size and surgeon experience on the surgical outcomes of laparoscopically-assisted vaginal hysterectomy (LAVH) for benign gynecological conditions.
Material and methods: This was a retrospective analysis of 184 LAVH cases. All hysterectomies were performed by the same surgeon and divided into two groups, with uterine weight of < 280 g (group 1) and uterine weight of > 280 g (group 2). The groups were compared in terms of the effects of the uterine size and surgeon experience vs. the operative outcomes (operative time, change in hemoglobin levels, hospital stay, and perioperative complications).
Results: No significant differences in mean age, parity, history of chronic systemic diseases and previous surgery history were observed between the two groups. However, operative time was significantly greater in group 2 as compared to group 1 (132.1 ± 42.7 minutes vs. 111.5 ± 30.4 minutes, p < 0.05). There were no differences in the hospital stay and perioperative complications between the two groups. One case of bladder injury occurred in each group and one patient underwent a second laparoscopic surgery for postoperative bleeding in group 2. Greater surgeon experience was demonstrated to be associated with decreased operative bleeding and, consequently, smaller differences between preoperative and postoperative hemoglobin levels. Operative time was also reduced as the surgeon was getting more experienced but the effect did not reach statistical significance.
Conclusions: Our study supports the thesis that LAVH is a safe and effective procedure for managing benign gynecological conditions. Despite increased operative time, LAVH can be safely performed for enlarged uterus in conjunction with increased surgeon experience.
Keywords
laparoscopic assisted vaginal hysterectomy; large uterus; surgeon experience
Title
Laparoscopically-assisted vaginal hysterectomy for enlarged uterus: operative outcomes and the learning curve
Journal
Issue
Article type
Research paper
Pages
333-337
Published online
2016-06-02
Page views
1439
Article views/downloads
1601
DOI
Pubmed
Bibliographic record
Ginekol Pol 2016;87(5):333-337.
Keywords
laparoscopic assisted vaginal hysterectomy
large uterus
surgeon experience
Authors
Mehmet Dolanbay
Mehmet S. Kutuk
Mahmut T. Ozgun
Semih Uludag
Yılmaz Sahin