Laparoscopic supracervical hysterectomy (LASH), a retrospective study of 1,584 cases regarding intra- and perioperative complications.

摘要

The main interest of this study was to assess the rate of intraoperative and perioperative complications of laparoscopic supracervical hysterectomy (LASH) in a teaching hospital.A retrospective analysis of 1,584 laparoscopic assisted hysterectomies between 2005 and 2010 by different surgeons.In 2,577 patients undergoing simple hysterectomy, an indication for LASH was present in 1,584 cases. Indications were uterine myomas (71.6%), dysfunctional uterine bleeding (12.6%), suspicion of adenomyosis uteri (8.9%), descensus uteri (2.8%), dysmenorrhea (2.8%), hysterectomy on demand (1.2%) and benign hyperplasia of the endometrium (0.2%). Mean duration of the procedure was 76.5 ± 33.4 min (95% CI, ± 1.66). The average age of patients was 45.9 ± 5.4 years (95% CI, ± 0.27). Mean body mass index (BMI) was 25.3 ± 4.9 (95% CI, ± 0.24). Adhesiolysis due to earlier surgery had to be performed in 190 (12%) cases. The total complication rate was 1.07%. The total conversion rate to laparotomy was 0.88%. The rate of conversion after laparoscopic assessment of the situs was 0.57%. In five cases, conversion to laparotomy was necessary due to intraoperative complications (0.32%). On the whole, six bleedings (0.38%), four bladder injuries (0.25%), three intestinal injuries (0.19%), one ureter injury (0.06%), one injury of the epigastric vein (0.06%) and two omental incarcerations (0.13%) occurred.In this retrospective analysis, the rate of complications for LASH was very low in a hospital of standard care and residency. LASH has to be considered as a minimally invasive method with a low perioperative morbidity to treat benign uterine pathologies even in a teaching setting and should therefore be the method of choice if the cervix can be preserved.