Total laparoscopic hysterectomy versus total abdominal hysterectomy in the treatment of benign gynaecological disease: a retrospective review over 5 years

Hysterectomy remains one of the most common gynaecological procedures performed in the UK. However, unlike other parts of Europe and America, where laparoscopic hysterectomy (LH) rates have significantly increased, in the UK, abdominal hysterectomy (AH) rates remain high and often the first choice for many surgeons. The minimal access route offers significant patient benefits over open surgery, and the purpose of this study was to evaluate the role of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) in the management of benign gynaecological conditions. This retrospective study was carried out over a 5-year period, and 296 procedures were included. Outcome measures included operating time, estimated blood loss (EBL), intraoperative and postoperative complications, postoperative analgesia requirements and length of hospital stay. TLH was associated with a significantly lower mean operating time (63.4 versus 75.3 min, P = <0.001) and reduced EBL (145.1 versus 277.0 ml, P = <0.001). Intraoperative complications were significantly less in the TLH group (1.9 versus 7.0 %, P = 0.029) with no ureteric injuries noted. Postoperative complications were also lower (6.8 versus 15.6 %, P = 0.016). TLH was also associated with significantly less analgesia requirements, with fewer requiring breakthrough analgesia (6.2 versus 26.6 %, P = <0.001), and a significantly shorter inpatient hospital stay (1.7 versus 3.0 days, P = <0.001). The results from our study highlight that TLH is superior to TAH in all operative outcome measures. With adequate training and experience, TLH is a safe, reproducible technique that should be offered to all women requiring a hysterectomy for a normal sized uterus in the absence of significant adhesions.