Trend changes in the proportion of minimal invasive hysterectomies over a five-year period: A single-center experience

Dah-Ching Ding^{a, b}, Tang-Yuan Chu^{a, b}, Yu-Hsun Chang^{b, c}

^a Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
^b Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
^c Department of Pediatrics, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan

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Abstract
Objectives

The aim of this study was to assess the trend changes in the proportion of laparoscopic assisted vaginal hysterectomy (LAVH) at a single center over a 5-year period and to compare the surgical morbidity associated with LAVH and total abdominal hysterectomy (TAH).

Materials and Methods

A retrospective chart review was conducted covering all hysterectomies performed in 2002 and in 2006.

Results

A total of 101 patients in 2002 and 99 patients in 2006 had benign gynecological indications for hysterectomy. Out of these patients, 67 patients in 2002 and 53 in 2006 received TAH, while 34 patients in 2002 and 46 patients in 2006 received LAVH. Thus in 2002, 66.3% of patients underwent TAH, while in 2006 53.5% of patients underwent TAH. The percentage of patients with a previous surgical history was higher in the TAH group (57.4 % vs. 20.5% in 2006) but the blood loss was less in the LAVH group compared to the TAH group [median 200 mL (range 20–700 mL) in LAVH group vs. median 300 mL (50–1500) in TAH group; p < 0.001]. The average operative time and hospital stay were shorter for the LAVH group than the TAH group [120 minutes (60–400) vs. 121 minutes (60–240); p = 0.03 and 5 days (2–18) vs. 6 days (3–78); p < 0.001, respectively].

Conclusions

The use of LAVH increased from 33.7% to 46.5% over a 5-year period, perhaps due to improved techniques, the lower blood loss associated with LAVH, and LAVH's shorter operation time. Nevertheless, there remains a need to further increase the proportion of patients undergoing LAVH and to further improve the minimal invasive surgery techniques used for hysterectomy.

Keywords
Hemorrhage; Laparoscopy-assisted vaginal hysterectomy; Total abdominal hysterectomy