Clinical Outcomes of Modified Laparoscopic Hysterectomy

  Objective  To investigate the clinical significance of modified laparoscopic hysterectomy(MLH).

  Methods  Totally 71 patients received MLH in our hospital from June 2007 to May 2008.Their procedure characteristics and clinical outcomes including surgery duration, intra-operative blood loss, and complications were compared with those of 28 patients who received total laparoscopic hysterectomy(TLH)and 36 patients who received laparoscopic assisted vaginal hysterectomy(LAVH)during the same period.

  Results  Compared with TLH and LAVH group, the main modifications in MLH group included:suturing the vaginal vault via vaginal approach instead of laparoscopic approach; use of special uterus manipulator and novel electronic coagulation equipment(Biclamp); and reducing uterine volume with electric comminuter via laparoscopy before the circular amputation of vaginal wall(i.e in situ volume reduction)instead of reducing manually via vaginal approach.The mean uterine sizes in MLH, TLH, and LAVH group were equivalent to the gestational ages of(12.3±2.6), (10.3±1.9), and(11.6±2.2)weeks, respectively.Uterine volume reduction procedure was performed in 39 patients(54.9%)of MLH group, 3 patients(10.7%)of TLH group, and 18 patients(50.0%)of LAVH group, obviously, there was a significant difference between MLH and TLH group(P < 0.05).The mean surgery duration was 78.0 min in MLH group, which was significantly shorter than those in TLH group(90.4 min)and LAVH group(94.7 min)(both P < 0.05).The mean intra-operative blood loss was significantly higher in LAVH group(144.2 ml)than in MLH(81.3 ml)and TLH group(81.1 ml).The post-operative morbidity rate was 16.9%, 10.7%, and 13.9% in MLH, TLH, and LAVH group; obviously, there was a significant difference between MLH and TLH group(P=0.0439).One patient from MLH group and one patient from LAVH group experienced ureter injury, and one patient form TLH group suffered from post-operative vaginal vault bleeding.

  Conclusions  The use of special uterus manipulator and novel electronic coagulation equipment improves the feasibility of laparoscopic hysterectomy.In situ uterine volume reduction via laparoscope is an alternative method for uterine volume reduction.Suturing vaginal vault through vaginal approach is more practical than laparoscopic approach, especially for patients whose uterus volume needs to be reduced vaginally.