Page 12 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Total Laparoscopic Hysterectomies at Tertiary Care Center:

A Retrospective Analysis

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Ankush Ajmera , Shyamkumar Sirsam , Sasireka Kuppusamy , Rajat Sharma 4
Received on: 24 February 2022; Accepted on: 15 May 2022; Published on: 05 September 2023
AbstrAct
Background: After cesarean section, hysterectomy is the second most common procedure performed in the OBGY department. In this study,
we analyzed the safety and complications of total laparoscopic hysterectomy (TLH) at our tertiary care center. Total laparoscopic hysterectomy
is the preferred procedure over the laparotomy because of higher feasibility and lower postoperative complications.
Materials and methods: This is a retrospective cohort study conducted on 200 patients who underwent TLH due to various benign gynecological
conditions from January 1, 2017 to July 31, 2022. The statistical analysis was done using EPIINFO software.
Results: The mean age of the women undergoing TLH at our center was 42 years. About 52% of the women were having parity 2, 43% were
having a uterine size between 6 and 12 weeks. The most common symptom and indication for TLH were heavy menstrual bleeding (75.5%) and
AUB L (leiomyoma) is about 49%, respectively. The average blood loss in the study was 150 mL. The mean duration of surgery was 50 minutes.
The mean duration of hospital stay was 3 days. And 4% of the patients had intraoperative complications, 9% had postoperative complications
which were identified and managed successfully.
Conclusion: Laparoscopic gynecological surgeries are safe procedures in terms of feasibility in obese patients, minimal blood loss, and
postoperative complications in patients with benign uterine etiology. Greater technical challenges and advanced equipment with long learning
curve make it difficult for all surgeons to practice it.
Keywords: Hysterectomy, Laparoscopy, Minimally invasive surgey, Retrospective.
World Journal of Laparoscopic Surgery (2023): 10.5005/jp-journals-10033-1556

IntroductIon 1–4 Department of Obstetrics and Gynecology, Government Medical
Hysterectomy is mainly an age-old surgery practiced from ages College, Akola, Maharashtra, India
undergoing multiple modification in the technique, routes, etc. Corresponding Author: Rajat Sharma, Department of Obstetrics and
Hysterectomy can be done through these routes abdominal, Gynecology, Government Medical College, Akola, Maharashtra, India,
vaginal, or laparoscopic. After cesarean section, hysterectomy Phone: +91 9890974340, e-mail: rajatshrm578@gmail.com
is the second most common procedure performed in the OBGY How to cite this article: Ajmera A, Sirsam S, Kuppusamy S, et al. Total
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department. Recently, increasing number of surgeries done Laparoscopic Hysterectomies at Tertiary Care Center: A Retrospective
by minimally invasive approaches, that is., total laparoscopic Analysis. World J Lap Surg 2023;16(1):11–14.
hysterectomy (TLH) and laparoscopic-assisted vaginal hysterectomy Ethical approval: Yes. (Reference No.-110/2022)
(LAVH). Total laparoscopic hysterectomy is the preferred approach Source of support: Nil
over other modalities due to fewer complications and faster patient Conflict of interest: None
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recovery. Most of the laparotomies for hysterectomies can be
avoided by using the laparoscopic approach in cases of adhesions
and extensive endometriosis. Most surgeons do not prefer the Inclusion criteria: All cases of benign gynecological condition,
vaginal approach because of the inaccessibility to adnexal masses uterine size less than 18 weeks, patients fit to undergo laparoscopic
and difficulty in patients with narrow introitus and uterine sizes surgeries.
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of more than 12 weeks. Laparoscopic approach has its own Exclusion criteria: Suspected or confirmed malignant
advantages and pitfall. 2,4–7 gynecological cases, uterine size more than 18 weeks, patients unfit
The advantages are smaller wound, shorter hospital to undergo laparoscopic surgeries.
stays, speedy recovery, decreased surgical site infection. The Patient’s demographic details, complete patient’s profile were
disadvantages are a long learning curve, high cost, and longer accessed after ethical committee and institution’s head approval.
operative time. 2,4–7 The aim of the study is to analyze the pros and The type of anesthesia decided is based on the patient profile.
cons of laparoscopic approach for benign uterine pathology at The team consists of anesthetist, two main surgeons, one assistant
rural setup. for holding camera, and one assistant for uterine manipulation, staff
nurse, and OT staff for assistance. Patient was placed in modified
Lloyd-Davis position. Primary 10 mm port insertion was done by
MAterIAls And Methods direct trocar entry; port was always inserted in supraumbilical site
This is a retrospective cohort study reviewed for 200 patients who 1 inch above the umbilicus. After the creation of pneumoperitoneum,
underwent TLH at our institute from January 1, 2017 to July 31, 2022. three 5 mm accessories port were introduced. (Two lateral trocar

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