Clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy:

Background. To evaluate clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy. Methods. Fifty women scheduled for abdominal hysterectomy were randomized to undergo either laparoscopic ( n =25) or abdominal ( n =25) hysterectomy. Surgical characteristics, hospital stay, convalescence and complications were analyzed. Blood samples for assay of markers of tissue trauma (interleukin‐6, C‐reactive protein, tumor‐associated trypsin inhibitor and tumor‐associated antigen CA 125) were taken preoperatively, on the first, second and seventh postoperative day and at the follow‐up visit four weeks after surgery. Results. In uncomplicated hysterectomies ( n =18) the operating time (85.3 min versus 57.5 min, p <0.00001) was longer for laparoscopic group but the hospital stay (2.1 days versus 3.4 days, p <0.00001) and sick leave (21.4 days versus 38.5 days, p <0.00001) were shorter in the laparoscopic group. Postoperative increases in all markers were significant in both groups. The interleukin‐6 concentration was highest on the first postoperative day in both groups, that of C‐reactive protein on the second postoperative day in both groups, tumor‐associated trypsin inhibitor on the seventh postoperative day in the laparoscopic group and on the second postoperative day in the abdominal group and tumor‐associated antigen CA 125 on the seventh postoperative day in both groups. Both interleukin‐6 and C‐reactive protein levels were lower in the laparoscopic group on the first ( p =0.01 and p =0.03, respectively) and on the second postoperative day ( p =0.02 and p <0.001, respectively) compared with the abdominal group. No differences were seen in tumor‐associated trypsin inhibitor and tumor‐associated antigen CA 125 levels between the groups. Conclusion. Laparoscopic hysterectomy should replace abdominal hysterectomy whenever possible because of a more favorable clinical outcome and less tissue trauma.