Page 20 - World Journal of Laparoscopic Surgery

Sheriff Z Kotb et al
Table 6: Intraoperative complications Table 7: Early postoperative findings
Group 1: Group 2: Group 1: Group 2:
Items LAVH HALH Total p-value Items LAVH HALH p-value
Number 21 20 41 Number 21 20
Anesthetic 0 0 0 Mean postoperative 11.24 ± 0.37 8.90 ± 1.89 0.010*
problems analgesic consumption
Intraoperative 1 (4.8%) 0 1 (2.4%) 0.323 (75 mg Diclofenac Na)
bleeding Mean flatulence relief 27.81 ± 12.62 28.50 ± 4.10 0.814
Bladder injury 2 (9.5%) 0 2 (4.9%) 0.157 time (hours)
Ureteric injury 0 0 0 — Mean ambulation 3.00 ± 1.22 2.50 ± 0.61 0.108
Bowel injury 0 0 0 — (nurse shifts)
Vascular injury 0 0 0 — Mean hospital stay 4.57 ± 1.50 3.45 ± 0.94 0.007*
Conversion 2 (9.5%) 0 2 (4.9%) 0.157 (days)
LAVH: Laparoscopic-assisted vaginal hysterectomy; HALH: *Significant; LAVH: Laparoscopic-assisted vaginal hysterectomy;
HALH: Hand-assisted laparoscopic hysterectomy
Hand-assisted laparoscopic hysterectomy

bleeding]) and one case in the HALH group due to wound No cases were readmitted in the second group. No
infection (Table 8). case had a recurrence until the end of the study (mean
No significant difference was found between both follow-up period was 24 months, the highest is 36
groups as regards resumption of ordinary daily activities. months), as shown in Table 10.
But the mean duration of resumption of coital activities Our study found that hand piece in laparoscopic
(if there were) was significantly lower in the HALH hysterectomy allows for tactile sensation, easy specimen

group (47.67 days) than in the LAVH group (58.00 days) retrieval through hand-port site, rapid control of bleeding
(Table 9). by manual pressure, improved depth perception, and
shortened learning curve. It avoids conversion to open
Table 8: Early postoperative complications approach and reduces operative time. On the contrary,
Group 1: Group 2: p- the hand piece in laparoscopic hysterectomy has some
Items LAVH HALH Total value drawbacks as hand encroaches upon intra-abdominal
Number 21 20 41 working space, requires large incision, and device-
Fever 4 (19.0%) 1 (5.0%) 5 (12.2%) 0.169 dependent air leak was reported frequently. It is also
Wound infection 1 (4.8%) 1 (5.0%) 2 (4.9%) 0.972
Urinary tract infection 3 (14.3%) 0 3 (7.3%) 0.079 ergonomically unfavorable, leading to shoulder and
Hematomas 0 0 0 — forearm fatigue and strain. It also increases the costs of
Deep venous 0 0 0 — the operation (Table 11).
thrombosis
Revision/ 0 0 0 — Table 10: Late postoperative complications
secondary studies Group 1: Group 2:
LAVH: Laparoscopic-assisted vaginal hysterectomy; HALH: Items LAVH HALH Total p-value
Hand-assisted laparoscopic hysterectomy Number 21 20 41
Vesicovaginal 1 0 1 0.323
Table 9: Late postoperative findings fistula
Group 1: Group 2: Incisional hernia 0 0 1 0.323
LAVH HALH p-value Readmission 1 0 2 0.927
Number 21 20 LAVH: Laparoscopic-assisted vaginal hysterectomy; HALH:
Mean time for regaining 25.00 ± 23.25 ± 0.564 Hand-assisted laparoscopic hysterectomy
daily activities (days) 12.35 5.45
Mean time for regaining 15 † 15 † 0.018*
coital activities (days) in 58.00 ± 47.67 ± DISCUSSION
sexually active cases 13.73 7.29 In most studies about laparoscopic hysterectomy,
†This number represents only cases who are sexually active dysfunctional uterine bleeding is a major indication.
*Significant; LAVH: Laparoscopic-assisted vaginal hysterectomy;
HALH: Hand-assisted laparoscopic hysterectomy This is different from our study which is restricted to
cases with tumors. In our study, uterine fibroids and
endometrial carcinoma comprised 78% of indications in
Late Postoperative Complications
both groups.
Wo cases in the first group were readmitted, one for Our series of LAVH with mean operative time of
repair of vesicovaginal fistula and the other for repair of 131.5 min is comparable with that of other studies: Ikram
10
11
12
incisional hernia (after laparotomy to control bleeding). et al (178.0 min); Park et al (253.8 min); Hong et al
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