Advantages of Total Laparoscopic Hysterectomy
Hysterectomies is a major surgical procedures all over the world, with over 600,000 performed each year. For decades, abdominal and vaginal approaches represent the vast majority of hysterectomies. With the advent of laparoscopic improved technology has led to the first total laparoscopic hysterectomy (TLH) in 1989. Using TLH has increased over the last 20 years. TLH was 9.9% of all hysterectomies in 1997 and 11.8% in 2003.
TLH defined laparoscopic ligation artery and vein removal of the ovaries uterus vaginally or abdominally and closing laparoscopic vaginal vault. This is in contrast with other engraving techniques of the uterus, fallopian tubes and ovaries. Supracervical laparoscopic hysterectomy is finished in a similar manner, except that the bar is cut after occlusion ascending vascular pedicles. Assisted laparoscopic hysterectomy (LAVH), the forerunner of the TLH is a technique to ensure vascularization ovaries and uterus laparoscopically. The rest of the procedure was completed vagina.
Laparoscope often again after the closure of the vaginal cuff sleeve examine the stomach and vagina for a sufficient hemostasis at the end of the process. This procedure requires a sufficient reduction in the uterus safe vaginal part of the process. Laparoscopic radical hysterectomy has emerged as an alternative for abdominal radical hysterectomy in patients with cervical cancer stage I. Emerging trends including robotic-assisted, laparoscopic one incision laparoscopic pelvic reconstructive surgery and laparoscopic hysterectomy.
TLH advantages over abdominal hysterectomy are well documented. Visualization of pelvic anatomy and the ability to minimize blood loss more than TLH. A vital approach and energetic uterus vessel, vagina and rectum is possible from many points of view, especially after the introduction of the uterine manipulator in 1995 were firmly established Advantages of TLH including reducing morbidity short term (less blood loss, wound infection and postoperative pain), short stay in hospital and faster return to normal activities compared with abdominal hysterectomy. The main objective of this chapter is to review the indications, surgical techniques and the benefits of HTL for women who are candidates for a hysterectomy.
The 2009 Cochrane review evaluated 27 randomized trials to determine the most appropriate type of hysterectomy for benign gynecological conditions controlled. This meta-analysis concluded that there are no differences between vaginal together with laparoscopic hysterectomies for the following factors: a return to normal activity, conversion to laparotomy and length of hospital stay. Morbidity rates comparing these two types of hysterectomies were similar incidence of pelvic hematoma, vaginal infections, urinary tract infections, respiratory infections and venous thromboembolism. Injury to the urethra and bladder are more common with TLH compared TAH; However, TLH tract lesions were similar to those that pass through the vaginal hysterectomy.
This meta-analysis, however, it is enough to detect a clinically significant increase in the incidence of injury to the bladder or urethra TLH increase. Most data on injuries urinary tract derived from non-randomized trials. TLH other benefits include a reduced risk of wound infection (in the abdominal wall and cut) and blood loss. The incidence of major surgical complications (bleeding, visceral injury, pulmonary embolism, wound breakdown, anesthetic difficulties and conversion to laparotomy) occurred with 11% TLH compared with 6% HST. The times were longer for TLH compared lava work, TAH or HST, as did lava and time T comparable performance. Shorter time operational obtained for the HST. Most of these studies reflects the early experience with HTL. Terminal laparoscopy study evaluated in two different time periods, which showed a reduced rate of conversion to laparotomy, the incidence of major complications and uptime. Another study evaluated the results of using the number of hysterectomies performed; He said that after 30 procedures, conversion to laparotomy rate decreased from 9.2% to 2.4%. Opening hours decreased with experience, but the rate of serious complications remained stable.
TLH potential benefits include hospital, faster return to normal activities, and less use of postoperative pain medication compared with TAH. Comparison of the HST TLH show the same length of stay and level of postoperative pain. Newer article Ghezzi et al point out a better profile of pain and a shorter hospital stay for a day in patients undergoing TLH against vaginal hysterectomy for benign disease. Surgical results, but not to the extent that the primary outcome of the study, also favored laparoscopic hysterectomy. Operations were 5 minutes for laparoscopic cases and similar rates of conversion to laparotomy, there Intraoperative complications and intraoperative blood loss.
However, according to the American College of Obstetricians and Gynecologists View 2009 Committee, which seems to be generally the most common HST for hysterectomy in the right patient based on the documented benefits and lower rates of access complications. Future research should further consider the advantages TLH against conventional approaches hysterectomy, but some of the advantages of laparoscopy for the patient seems clear at this point.
Some conflicting evidence about the effectiveness of the cost of TLH. Meta-analysis of 12 randomized controlled trials looking at the costs of TAH compared to HTL. Total cash flow for TLH was 6.1% higher than TAH, while total costs TLH is half the cost of TAH. The study concluded that the hospital stay is shorter and reduced mortality in the laparoscopic group offsets surgery costs increased likened to TAH. Value of life studies in 2008 also stated TLH or better in terms of health and postoperative quality of life in the first few weeks after surgery. The decision on access to hysterectomy, and has published short stay in hospital benefits and a better quality of life must be weighed against the possibility of an increased risk of complications, although the literature has not yet reached a conclusion regarding the risks of existing complications.
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