Page 33 - World Journal of Laparoscopic Surgery

A Comparative Evaluation of Total Laparoscopic Hysterectomy and Laparoscopic Supracervical Hysterectomy
that LSH is associated with a more rapid postoperative recovery in was obtained by subtracting the mean 24 hours postoperative
terms of resumption of normal activity than a total laparoscopic hemoglobin from the mean preoperative hemoglobin. Follow-up
5,6
hysterectomy (TLH). LSH is also been considered as the best was done at periodic intervals (1 week, 1 month, 2 months, 3 months,
surgical approach for abnormal uterine bleeding (AUB) by some and 6 months after the surgery) and complaints, condition of wound,
authors as the overall patient satisfaction was quite high. 7 recuperation from surgery, bladder, bowel, and sexual function were
Most of the literature regarding LSH is coming from developed noted on each follow-up visit.
countries. In India, TLH is a common surgery but we could not find Statistical analysis was done on software SPSS (SPSS Inc.,
any data on LSH, might be because it is not popular in developing Chicago, IL) using the Fisher’s test, Student’s t-test, and Mann–
countries due to high risk of cervical neoplasia, non-availability of Whitney test. A value of p < 0.05 was accepted as significant.
regular cervical cancer screening and unawareness when available.
Therefore, we conducted this study to evaluate the safety (risks results
vs benefits) of LSH in the Indian scenario when compared with TLH
in terms of intraoperative and postoperative outcome measures. A total of 55 patients were assessed for eligibility, out of which 30
Furthermore, quality of life (bladder, bowel, and sexual functions) patients were included in the study based on eligibility criteria. Fifteen
was also evaluated. patients underwent LSH and another 15 patients underwent TLH after
randomization. Flowchart 1 shows the flow diagram of the study.

MAteriAls And Methods Flowchart 1: Flow diagram of the study
It was a prospective randomized study conducted in the
Department of Obstetrics and Gynaecology, All India Institute of
Medical Sciences, New Delhi for 2 years. The study was reviewed
and approved by the Institutional ethical board. All the patients
presented to gynaecology OPD were invited to participate in the
study. A total of 30 patients having a benign disease of the uterus
with a surgical indication for hysterectomy who were willing to
comply with the protocol and regular follow-up were included in
the study. Patients with premalignant and malignant disease of
uterus, cervix or ovaries/adnexa, complex adnexal mass, pregnancy,
genital prolapse, coagulation disorders, and patients unfit for
anesthesia were excluded from the study. Informed and written
consent was obtained from all the patients. Women undergoing
LSH were also counseled about the need for pap smear screening.
Patients were divided randomly into LSH (n = 15) and TLH (n = 15)
groups by a computer-generated randomization list. All patients
underwent detailed preoperative evaluation including a complete
history, physical and pelvic examination, Papanicolaou (PAP) smear,
endometrial aspiration (EA), transvaginal ultrasonography (using
6.5 MHz vaginal transducers, ultrasound machine- GEC LOGIQ 3
PRO), and routine laboratory tests. All surgeries were done by the
same surgeon.
Apart from routine steps of TLH, the body of the uterus
was amputated from the cervix after bilateral uterine arteries
coagulation and the endocervical canal was cauterized with bipolar
cautery in LSH. The uterus was then morcellated using an electronic Demographic characteristics were similar in both the groups
uterine morcellater. (Table 1). Most common indication was fibroid uterus. Incidentally,
Intraoperative outcome measures, such as operation time, blood five patients in LSH group had previous cesarean (p = 0.042) while
loss, visceral injuries (bladder, bowel, ureter), need for blood transfusion the groups were divided by randomization, which might be because
(BT), conversion to laparotomy, and weight of uterus were noted. of the small sample size.
Postoperative outcome measures included absolute change in Table 2 demonstrates perioperative outcomes. Operative time
hemoglobin (Hb), fever, pain, BT, duration of hospital stay, urinary and blood loss were higher in LSH group though, the difference
complaints (retention, dysuria), wound infection, duration and the was not significant. The absolute fall in Hb was significantly more
number of doses of analgesic drugs given, and readmission. Operation in LSH group (p = 0.001). We did not find any significant difference
time was calculated from the skin incision to skin closure. Postoperative in VAS score on day 0 and day 7 but VAS score on day 1 and mean
pain was evaluated from the visual analog scale (VAS), ranges from duration of injectable analgesics was significantly less in LSH group.
0 to 10 as no pain to worst pain possible. As a routine, injectable Recuperation from the surgery was similar in both the groups
analgesic was discontinued on a postoperative day one in all patients except the number of days to return to routine activity was
and further doses were given only on demand. Oral analgesic was significantly less in patients who underwent TLH compared to LSH
given in the form of a fixed dose combination of ibuprofen 400 mg group (p = 0.02). Patients in both groups reported no significant
and paracetamol 500 mg. The number of analgesic tablets and vials change in their bladder, bowel, and sexual function. Resumption of
requested by the patients was also recorded. Hemoglobin was sent in sexual activity was earlier in the LSH group though, the difference
all patients 24 hours after surgery. The absolute change in hemoglobin was not statistically significant (Table 3).

World Journal of Laparoscopic Surgery, Volume 14 Issue 1 (January–April 2021) 31