Potential complications include the following:
From December 1991 to December 1996, a total of 263 operative pelviscopic intrafascial hysterectomies were performed by the author and his colleague T.S. AHN, M.D. at Carroll County General Hospital, Westminster, Maryland (USA). Additional C*I*S*H* were performed by the authors in various states of the USA, in Germany and Korea, bringing the total to about 300 cases.
There were no major complications in our series. Our experience is documented in the following tables:
Number of patients...........................263 Age...................24-84..................(43) Weight(lbs)...........97-274................(186) Parity.................0-7..................(3.5)
12/91-9/95............211 pts.......1'12"-6'45"(3'10") 10/95-12/96............52 pts.......1'30"-3'54"(2'18") Analysis of 52 pts. 10/95-12/96: <2 hrs.................12 pts............23% 2-3 hrs................34 pts............65% >3 hrs..................6 pts............12% 6 pts. who took more than 3 hrs.: 2 pts.; combined with lysis of extensive abd.-pelvic adhesions 3 pts.; extensive pelvic endometriosis 1 pt..; undetermined ovarian cyst, frozen section
211 pts. 12/91-9/95
24 hrs........7 pts. ( 3.3%)
48 hrs......187 pts. (88.7%)
72 hrs.......17 pts. ( 8.0%)
52 pts. 10/95-12/96
24 hrs.......13 pts. (25.0%)
48 hrs.......35 pts. (67.4%)
72 hrs........4 pts. ( 7.6%)
Analysis of 4 pts. who stayed 72 hrs:
2 pts.; paralytic ileus
1 pt.; vertigo
1 pt.; elderly with medical problems
With a skilled and organized operating team we have been able to reduce the operating time to about two hours in more than 80% of cases. Patients do better postoperatively which is reflected in a reduced hospital stay.
Blood loss was consistently lower than at conventional abdominal or vaginal hysterectomy, ranging from 100-350 ml. No patient required a blood transfusion.
We had the following minor complications:
Following a strict operative protocol as outlined in previous chapters, we have been able to avoid all major potential complications.
Reports of severe complications and of misuse and overuse of the laparoscope are numerous, without demonstrating real physical, psychological, and financial advantages for the patient over traditional hysterectomies. It is suggested, if specific indications and criteria for hysterectomies were established, comparitive studies would indicate primary vaginal hysterectomy to be possible in 77% (France), 95%(England), and about 80%(USA)of cases. In the remaining cases the laparoscope would play a diagnostic role in about 10%; laparotomy would be unavoidable in the rest.
Analyzing our experience with hysterectomies over the past 4½ years, we can demonstrate that the laparoscope plays a major role in our hysterectomies.
Dec.1991-June 1996
Total cases..........308(100%)
C*I*S*H*.........250(81.0%)
TAH.............. 10( 3.3%)
TVH.............. 23( 7.5%)
LAVH............. 25( 8.2%)
Indications for TAH
Suspicion for ovarian cancer......4
Adenocarcinoma of endometrium.....3
Multiple large myomas.............2
Impacted cervical myoma...........1
Total.....10
Indications for TVH
Prolapse with pelvic floor repair...22
Cervical intraepitheal neoplasia.....1
Total........23
Indications for LAVH
Myomas and descensus with pelvic floor repair.....11
Atypical endometrial hyperplasia...................7
Cervical myoma.....................................1
Adenocarcinoma of endometrium......................3
CIN and recurrent abdominal pain...................2
Patient's request for cervical removal.............1
Total.......................25[prev.page] [next page] [contents] [home]
P.F. Vietz, M.D.
September 1997