Top

Published in:

01-01-2012 | General Gynecology

The Hohl instrument for optimizing total laparoscopic hysterectomy: results of more than 500 procedures in a university training center

Authors: Andreas Mueller, Alexander Boosz, Martin Koch, Sebastian Jud, Florian Faschingbauer, Michael Schrauder, Christian Löhberg, Grit Mehlhorn, Stefan P. Renner, Michael P. Lux, Matthias W. Beckmann, Falk C. Thiel

Published in: Archives of Gynecology and Obstetrics | Issue 1/2012

Abstract

Purpose

To evaluate complication rates associated with total laparoscopic hysterectomy (TLH) using the Hohl instrument in women with benign indications for hysterectomy, a prospective cohort study was conducted in a university teaching hospital.

Methods

A total of 567 women with benign indications for hysterectomy underwent the TLH procedure using the Hohl instrument between January 2005 and July 2009. The laparoscopic approach was used when the patient had undergone more than one previous pelvic abdominal operation, when an adnexal finding was present, and/or if the patient had reduced vaginal capacity.

Results

One ureteral injury (0.18%), four bladder injuries (0.71%), one small-bowel injury (0.18%), one vaginal injury (0.18%), and one conversion to abdominal hysterectomy (0.18%) occurred. The general complication rate during surgery was 1.42%, whereas in the postoperative period was 3.19%. The mean loss of hemoglobin was 1.47 g/dL (SD 1.06), the mean operating time was 103.87 min (SD 43.89), and the mean uterus weight was 241.41 g (SD 196.73).

Conclusions

Total laparoscopic hysterectomy using the Hohl instrument simplifies the surgical procedure. The technique reported here is safe and effective in preventing ureteral complications during TLH, even in a university training program.

Benassi L, Rossi T, Kaihura CT et al (2003) Abdominal or vaginal hysterectomy for enlarged uteri: a randomized clinical trial. Am J Obstet Gynecol 187:1561–1565CrossRef

Ayoubi JM, Fanchin R, Monrozies X, Imbert P, Reme LM, Pons JC (2003) Respective consequences of abdominal, vaginal and laparoscopic hysterectomies on women’s sexuality. Eur J Obstet Gynecol 111:179–182CrossRef

Ribeiro SC, Ribeiro RM, Santos NC, Pinotti JA (2003) A randomized study of total abdominal, vaginal and laparoscopic hysterectomy. Int J Gynecol Obstet 83:37–43CrossRef

Lenihan JP, Kovanda C, Cammarano C (2004) Comparison of laparoscopic-assisted vaginal hysterectomy with traditional hysterectomy for cost-effectiveness to employers. Am J Obstet Gynecol 190:1714–1722PubMedCrossRef

Malur S, Possover M, Michels W, Schneider A (2001) Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: a prospective randomized trial. Gynecol Oncol 80:239–244PubMedCrossRef

Johnson N, Barlow D, Lethaby A, Tavender E, Curr E, Garry R (2006) Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2:CD003677PubMed

Nieboer TE, Johnson N, Lethaby A et al (2009) Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev (3):CD003677

O’Hanlan KA, Huang GS, Lopez L, Garnier AC (2004) Selective incorporation of total laparoscopic hysterectomy for adnexal pathology and body mass index. Gynecol Oncol 93:137–143PubMedCrossRef

O’Hanlan KA, Lopez L, Dibble SL et al (2003) Total laparoscopic hysterectomy: body mass index and outcomes. Obstet Gynecol 102:1384–1392PubMedCrossRef

10.

Heinberg EM, Crawford BL, Weitzen SH, Bonilla DJ (2004) Total laparoscopic hysterectomy in obese versus nonobese patients. Obstet Gynecol 103:674–680PubMedCrossRef

11.

McCartney AJ, Obermair A (2004) Total laparoscopic hysterectomy with a transvaginal tube. J Am Assoc Gynecol Laparosc 11:79–82PubMedCrossRef

12.

Altgassen C, Michels W, Schneider A (2004) Learning laparoscopic-assisted hysterectomy. Obstet Gynecol 102:308–313CrossRef

13.

Wu MP, Lin CC, Tian YF et al (2004) The feasibility of an internal bladder retractor in facilitating bladder dissection during laparoscopic-assisted vaginal hysterectomy. J Am Assoc Gynecol Laparosc 11:283–284PubMedCrossRef

14.

Koh LW, Koh PH, Lin LC et al (2004) A simple procedure for the prevention of ureteral injury in laparoscopic-assisted vaginal hysterectomy. J Am Assoc Gynecol Laparosc 11:167–169PubMedCrossRef

15.

Garry R, Fountain J, Mason S et al (2004) The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ 328:129–136PubMedCrossRef

16.

Canis MJ, Wattiez A, Mage G, Bruhat MA (2004) Results of eVALuate study of hysterectomy techniques: laparoscopic hysterectomy may yet have a bright future. BMJ 328:642–643PubMedCrossRef

17.

Kreiker GL, Bertoldi A, Larcher JS et al (2004) Prospective evaluation of the learning curve of laparoscopic-assisted vaginal hysterectomy in a university hospital. J Am Assoc Gynecol Laparosc 11:229–235PubMedCrossRef

18.

Chang WC, Li TC, Lin CC (2003) The effect of physician experience on costs and clinical outcomes of laparoscopic-assisted vaginal hysterectomy: a multivariate analysis. J Am Assoc Gynecol Laparosc 10:356–359PubMedCrossRef

19.

Ostrzenski A, Radolinski B, Ostrzenska KM (2003) A review of laparoscopic ureteral injury in pelvic surgery. Obstet Gynecol Surv 58:794–799PubMedCrossRef

20.

Malzoni M, Perniola G, Perniola F, Imperato F (2004) Optimizing the total laparoscopic hysterectomy procedure for benign uterine pathology. J Am Assoc Gynecol Laparosc 11:211–218PubMedCrossRef

21.

Ou CS, Joki J, Wells K et al (2004) Total laparoscopic hysterectomy using multifunction grasping, coagulation, and cutting forceps. J Laparoendosc Adv Surg Tech 14:67–71CrossRef

22.

Margossian H, Falcone T (2001) Robotically assisted laparoscopic hysterectomy and adnexal surgery. J Laparoendosc Adv Surg Tech 11:161–165CrossRef

23.

Hohl MK (2001) Der Uterus-Manipulator n. Hohl. EndoWorld GYN No. 16-D. Karl Storz, Ltd., Tuttlingen, Germany

24.

Mueller A, Oppelt P, Ackermann S, Binder H, Beckmann MW (2005) The Hohl instrument for optimizing total laparoscopic hysterectomy procedures. J Minim Invasive Gynecol 12:432–435PubMedCrossRef

25.

Thiel F, Renner S, Oppelt P et al (2006) Establishment of total laparoscopic hysterectomy (TLH) in a university gynecology department: results of the first 100 operations. Geburtshilfe Frauenheilkd 66:665–669CrossRef

26.

Mueller A, Renner SP, Haeberle L et al (2009) Comparison of total laparoscopic hysterectomy (TLH) and laparoscopy-assisted supracervical hysterectomy (LASH) in women with uterine leiomyoma. Eur J Obstet Gynecol Reprod Biol 144:76–79PubMedCrossRef

27.

Mueller A, Thiel F, Lermann J, Oppelt P, Beckmann MW, Renner SP (2010) Feasibility and safety of total laparoscopic hysterectomy (TLH) using the Hohl instrument in nonobese and obese women. J Obstet Gynaecol Res 36:159–164PubMedCrossRef

28.

Müller A, Thiel FC, Renner SP, Winkler M, Häberle L, Beckmann MW (2010) Hysterectomy—a comparison of approaches. Dtsch Arztebl Int 107:353–359PubMed

29.

Köhler C, Hasenbein K, Klemm P et al (2003) Laparoscopic-assisted vaginal hysterectomy with lateral transsection of the uterine vessels. Surg Endosc 17:485–490PubMedCrossRef

30.

Altgassen C, Michels W, Schneider A, Diedrich K (2005) Wie sicher ist die laparoskopisch assistierte vaginale Hysterektomie? Geburtshilfe Frauenheilkd 65:1051–1057CrossRef

31.

Fiaccavento A, Landi S, Barbieri F et al (2007) Total laparoscopic hysterectomy in cases of very large uteri: a retrospective comparative study. J Minim Invasive Gynecol 14:559–563PubMedCrossRef

32.

Wattiez A, Soriano D, Fiaccavento A et al (2002) Total laparoscopic hysterectomy for very enlarged uteri. J Am Assoc Gynecol Laparosc 9:125–130PubMedCrossRef

33.

Hur HC, Guido RS, Mansuria SM et al (2007) Incidence and patient characteristics of vaginal cuff dehiscence after different modes of hysterectomies. J Minim Invasive Gynecol 14:311–317PubMedCrossRef

34.

Robinson BL, Liao JB, Adams SF, Randall TC (2009) Vaginal cuff dehiscence after robotic total laparoscopic hysterectomy. Obstet Gynecol 114:369–371PubMedCrossRef

35.

Nick AM, Lange J, Frumovitz M et al (2011) Rate of vaginal cuff separation following laparoscopic or robotic hysterectomy. Gynecol Oncol 120:47–51PubMedCrossRef

36.

Jeung IC, Baek JM, Park EK et al (2010) A prospective comparison of vaginal stump suturing techniques during total laparoscopic hysterectomy. Arch Gynecol Obstet 282:631–638PubMedCrossRef

37.

Iaco PD, Ceccaroni M, Alboni C et al (2006) Transvaginal evisceration after hysterectomy: is vaginal cuff closure associated with a reduced risk? Eur J Obstet Gynecol Reprod Biol 125:134–138PubMedCrossRef

38.

Hohl MK, Hauser N (2010) Safe total intrafascial laparoscopic (TAIL) hysterectomy: a prospective cohort study. Gynecol Surg 7:231–239PubMedCrossRef

39.

Kluivers KB, Johnson NP, Chien P, Vierhout ME, Bongers M, Mol BW (2008) Comparison of laparoscopic and abdominal hysterectomy in terms of quality of life: a systematic review. Eur J Obstet Gynecol Reprod Biol 136:3–8PubMedCrossRef

40.

Ghezzi F, Uccella S, Cromi A et al (2010) Postoperative pain after laparoscopic and vaginal hysterectomy for benign gynecologic disease: a randomized trial. Am J Obstet Gynecol 203:118.e1–e8CrossRef

41.

Candiani M, Izzo S, Bulfoni A, Riparini J, Ronzoni S, Marconi A (2009) Laparoscopic vs vaginal hysterectomy for benign pathology. Am J Obstet Gynecol 200:368e1–368e7CrossRef

42.

Reich H, Decaprio J, McGlynn F (1989) Total laparoscopic hysterectomy. J Gynecol Surg 5:213–216CrossRef

43.

Canis M, Botchorishvili R, Ang C et al (2008) When is laparotomy needed in hysterectomy for benign uterine disease? J Minim Invasive Gynecol 15:38–43PubMedCrossRef

44.

de Lapasse C, Rabischong B, Bolandard F et al (2008) Total laparoscopic hysterectomy and early discharge: satisfaction and feasibility study. J Minim Invasive Gynecol 15:20–25PubMedCrossRef

45.

Kikuchi I, Takeuchi H, Shimanuki H et al (2008) Questionnaire analysis of recovery of activities of daily living after laparoscopic surgery. J Minim Invasive Gynecol 15:16–19PubMedCrossRef

46.

Koutoukos I, Langebrekke A, Busund B, Qvigstad E (2010) Laparoscopic hysterectomy: should the complications redefine the classification? Gynecol Surg 7:227–230CrossRef

Title: The Hohl instrument for optimizing total laparoscopic hysterectomy: results of more than 500 procedures in a university training center
Authors: Andreas Mueller
Alexander Boosz
Martin Koch
Sebastian Jud
Florian Faschingbauer
Michael Schrauder
Christian Löhberg
Grit Mehlhorn
Stefan P. Renner
Michael P. Lux
Matthias W. Beckmann
Falk C. Thiel
Publication date: 01-01-2012
Publisher: Springer-Verlag
Published in: Archives of Gynecology and Obstetrics / Issue 1/2012
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-011-1905-y

At a glance: The STEP trials

Springer Medicine

The Hohl instrument for optimizing total laparoscopic hysterectomy: results of more than 500 procedures in a university training center

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2012

Economic evaluation of multiplex ligation-dependent probe amplification and karyotyping in prenatal diagnosis: a cost-minimization analysis

Langerhans cell histiocytosis of the female genital tract: a literature review with additional three case studies in China

Adnexal torsion in a woman undergoing ovarian hyperstimulation with clomiphene citrate therapy: a case report and review of the literature

Reviewers 2011

PAPP-A levels of late pregnancy in preeclampsia and HELLP syndrome

Comparison of placental pathology between severe preeclampsia and HELLP syndrome