1. Comparison of Laparoscopic and Open Hysterectomy
B. Stitz MD
HELIOS St. Elisabeth Klinik Hünfeld
B.Stitz, HELIOS St. Elisabeth Klinik Hünfeld

2. The Purpose of the Study
to evaluate the procedure and the outcome of transvaginal, abdominal and laparoscopic hysterectomy
duration of the operation and anaesthesia
size of the uterus
blood loss
duration of hospitalisation
complications
B.Stitz, HELIOS St. Elisabeth Klinik Hünfeld

3. Preoperative Evaluation
Evaluation of dysfunctional uterine bleeding, pelvic pain, dysmenorrhoe, urinary frequency, incontinence, parity status
Inspection (pelvic floor deficiency, vaginal prolapse)
Palpation (size and mobility of the uterus, additional findings at ovaries and tubes, peritoneal adhesions after laparotomy and redo operations)
Sonography transvaginal and abdominal
B.Stitz, HELIOS St. Elisabeth Klinik Hünfeld

4. Patient Inclusion Criteria
Only patients treated with hysterectomy with/without salpingooophorectomy and/or McCall‘s suture were included.
Neither reconstruction of the pelvic floor (open or laparoscopic approach) nor incontinence procedures, adhesiolysis nor any other simultaneous operations were allowed, no patients with alloplastic implants were included.
N = 232
B.Stitz, HELIOS St. Elisabeth Klinik Hünfeld

5. Operation Techniques transvaginal or abdominal laparoscopic
Wertheim clamps and sutures
transvaginal or abdominal removal of the uterus
complete closure of the vagina
no complete suture of the peritoneum parietale
one 10mm and two 5mm trocars
ultrasound tissue dissection
transvaginal extraction of the uterus
complete closure of the vagina and of the peritoneum parietale from the inside
identical material and needles for sutures in all approaches
B.Stitz, HELIOS St. Elisabeth Klinik Hünfeld

6. Weight of the Removed Uterus
B.Stitz, HELIOS St. Elisabeth Klinik Hünfeld

7. Laparoscopic Hysterectomy Sept. 7th, 2004
Uterus 1911g
laparoscopic approach
B.Stitz, HELIOS St. Elisabeth Klinik Hünfeld

8. Duration of Operations
B.Stitz, HELIOS St. Elisabeth Klinik Hünfeld

9. Haemoglobin before/after Operation
B.Stitz, HELIOS St. Elisabeth Klinik Hünfeld

10. Blood Loss Perioperative
B.Stitz, HELIOS St. Elisabeth Klinik Hünfeld

11. Duration of Hospitalisation
B.Stitz, HELIOS St. Elisabeth Klinik Hünfeld

12. Results
As expected uteri removed by vaginal approach were significantly smaller than those removed laparoscopically or by laparotomy.
Blood loss showed no significant difference between vaginal and laparoscopic operation. It was, however, significantly lower than in abdominal approach.
Abdominal and laparoscopic procedures took more time than transvaginal operations.
Patients with laparoscopic operations were discharged earlier than those with vaginal hysterectomies. After abdominal operations patients needed twice the time to recover and for being discharged.
There was no significant difference in intra- and postoperative complications between the different approaches.
B.Stitz, HELIOS St. Elisabeth Klinik Hünfeld

13. Laparoscopic hysterectomy is a safe, fast and comfortable technique.
Conclusions
Laparoscopic hysterectomy is a safe, fast and comfortable technique.
Laparoscopic hysterectomy can particularly be recommended to replace most laparotomies done to remove even the large and heavy uterus.
For smaller uteri we found no advantage in comparison to the vaginal approach.
In our hospital almost 50% each of all hysterectomies following the described criteria in 2005 were performed by using vaginal and laparoscopic approach respectively. Only one laparotomy (0,55%) was needed.
B.Stitz, HELIOS St. Elisabeth Klinik Hünfeld