3. REFERENCES Laparoscopic techniques for hysterectomy : NICE Interventional procedure guidance 239, November 2007 Total laparoscopic hysterectomy: a 5 year experience : Ng CC & Chern BS. Arch Gynaecol Obstet. 2007 Dec: 276(6): 613-8 Total laparoscopic hysterectomy versus total abdominal hysterectomy: an assessment of the learning curve in prospective randomized study. Perino A et al. Human Reproduction. 2009; Vol.14 No.12: 2296-9

4. Previous audit ( presented in March 2013)Present audit Retrospective July 2010 – Feb 2013 [32 months]April 2013 – March 2015 (24 months) 33/37 cases analysed66/78 cases analysed 4/7 standards achieved Recommendations - Reduce length of stay to ≤ 3 days - Reduce re-admission rate

9. 4 cases- Adhesions in pelvis and difficulty in access 1 case - Deep pelvis, unable to get head down – asthmatic, BMI 53, EBL 750ml 1 case - Mesenteric tear bleed – noted after completion of TLH. Surgeon advised laparotomy * All had BMI 38-53, except for mesenteric bleed with BMI 26 * Size of uterus 10cm or less

10. All cases with EBL >= 500ml were convertion to laparotomy – 5

12. NICE classification of Obesity

13. 3 -5d - 10 cases No reason documented for prolonged stay

14. Auditable standardExpected ratePrevious auditRe-audit Conversion to laparotomy2 – 7%6%9% Transfusion4 – 5%9%4.5% Bladder/ureteric injury< 2%3%3%0 Bowel injury<1%00 Return to theatre [any cause]<3%3%1.5% Mean hospital stay<3d2.7d [79% - <3d]2d [93% - <3d] Readmission rate<4 %9%10%