Laparoscopic versus Open Hysterectomy

Published Date: 19th July 2016

Publication Authors: Tildesley R, Gilliland J, Dearden D, Kundodyiwa T

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Background 

Endometrial carcinoma accounts for 5% of cancers in women in the UK and is the second most common gynaecological cancer. Obesity is associated with a two- to fivefold increase in the risk of endometrial cancer in both pre and postmenopausal women. Overweight and obese patients have an increased risk of complications especially wound infections and prolonged hospital stay. The surgery itself is often more challenging and complicated. The role of laparoscopic surgery is to help reduce such complications, decrease hospital length of stay and improve the recovery period for our patients.

Objective 

The aim of the audit was to compare outcomes for patients undergoing laparoscopic assisted vaginal hysterectomy (LAVH) with patients having an abdominal hysterectomy for low grade endometrial cancers.

Methods 

A retrospective audit was performed looking at all women diagnosed with endometrial carcinoma at St Helen’s and Knowsley Teaching Hospital NHS Trust from June 2009 until January 2013. All patients were operated on by a single consultant gynaecologist. LAVH was performed when felt possible by the attending Consultant Gynaecologist. Notes were reviewed and data were collected regarding age at diagnosis, presentation, preoperative assessment for suitability for LAVH, pretreatment histology, BMI, ASA grade, co-morbidities, intraoperative complications, conversion rates, estimated blood loss, postoperative complications (immediate and late), length of inpatient stay, any re-admission to hospital within 14 days and the FIGO stage from histology.

Results 

One hundred and thirty-four patients were included in the audit. The results show that LAVH is associated with a shorter inpatient stay and reduced post operative complications, most notably wound infections.

Conclusion 

There are benefits for both our patients and the Trust by increasing the use of minimally invasive surgical techniques. Laparoscopic assisted hysterectomy has the potential to reduce both inpatient hospital length of stay and post operative complications.

Tildesley, R; Gilliland, J; Dearden, D; Kundodyiwa, T. (2013).  Laparoscopic versus open hysterectomy for the treatment of early endometrial cancer . BJOG: An International Journal of Obstetrics and Gynaecology. 120 (Supplement S1), 243-44

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