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Perioperative outcomes of total laparoscopic hysterectomy at a regional hospital in New Zealand
Author(s) -
Suisted Philip,
Chittenden Brad
Publication year - 2017
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.12570
Subject(s) - medicine , hysterectomy , perioperative , laparotomy , abdominal hysterectomy , laparoscopy , surgery , laparoscopic hysterectomy , blood loss , general surgery
Background Total laparoscopic hysterectomy ( TLH ) is established as a safe method of hysterectomy, with a satisfactory patient experience. However, most published data derive from high‐volume centres with experienced teams. It is not clear whether these data translate to smaller centres? Aims To evaluate the implementation of a minimally invasive option for hysterectomy at a regional public hospital in New Zealand. Materials and methods Prospective audit of 120 cases of TLH over three years. We retrospectively compared outcomes to the same number of abdominal ( AH ) and vaginal hysterectomy ( VH ). Results TLH and AH were predominantly performed for heavy menstrual bleeding (65 and 64%) and VH for prolapse (54%). The largest uteri were AH (range 30–3400 g), TLH (35–550) then VH (21–256). Compared to TLH , both AH and VH had shorter mean operating theatre times ( TLH 126.8 ± 44.8 min, AH 103.2 ± 32.8 and VH 93 ± 26.9), longer mean hospital stay ( TLH 51.3 ± 21.3 h, AH 101.9 ± 36.6 and VH 75.1 ± 31.3) and increased mean blood loss ( TLH 153 ± 116.1 mL , AH 517 ± 672.3 and VH 244 ± 206.8). One TLH was converted to laparotomy and one required interval laparoscopy. Major complications (2.5%) were lowest in the TLH group and were consistent with large international series. Conclusions TLH would appear to be a safe and effective local option. The outcomes for patients at a regional general hospital can replicate the results of larger centres.