The Journal of the American Association of Gynecologic Laparoscopists
Original ArticlesThe Learning Curve of Total Laparoscopic Hysterectomy: Comparative Analysis of 1647 Cases
Section snippets
Materials And Methods
From November 1989 to December 1999, 1647 women underwent total laparoscopic hysterectomy (TLH) due to benign pathology. At the beginning of 1996 we introduced a new uterine manipulator to prevent complications. Therefore, we compared complications rates before and after its introduction. In early (1989–1995) and recent years (1996–1999), 695 and 952 women underwent TLH, respectively. Inclusion criteria were benign uterine disorders and patient consent. Exclusion criteria were anesthetic
Results
No differences were found between time periods for patient age, parity, body mass index (BMI), premenopausal status, and previous abdominal or pelvic surgery (Table 1). There was no difference in indications for surgery between periods. The most common pathologic diagnoses in both periods were myoma, adenomyosis, and endometrial atrophy, with no significant differences between groups.
Significant decreases in major complications (blood transfusion; urinary, bowel and neurologic injuries;
Discussion
The present study, to our knowledge the largest reported to date from a single center, supports the feasibility and overall favorable outcome associated with TLH. Previous reports indicated that even experienced laparoscopists have complication rates of 5.8% to 11.5% and major complication rates of 2.2% to 2.7% after laparoscopic hysterectomy for the management of benign uterine pathology.12, 13 One meta-analysis reported a total complication rate of 15.6%,14 which was comparable with the
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