The advantages of the laparoscopic approach to benign gynaecology is no longer in doubt and in common compared to other methods of hysterectomy it is associated with:
Less blood loss
Less requirement for pain relief
Shorter hospital stay
Quicker recovery
Quicker return to normal activity
Quicker return to family life and work.
The one thing that was in doubt was the higher complication rate.
A popular study published in 2004 put the complication rate for laparoscopic hysterectomy at 11%, which was the highest when compared to the traditional open abdominal hysterectomy and vaginal hysterectomy.
However the flaw in this study was the validation of the chosen participants and it could be argued that the surgeons chosen were great open and vaginal surgeons but their laparoscopic surgery was not so great.
An expert laparoscopic unit in Belgium a few years later published a series of nearly 4000 women and they had a complication rate of less than 1%.
The difference and success rates are down to skill acquired by the surgeon as well as the workload. The more procedures that are done by the surgeon the greater the success.
Despite the recognized advantages and low complication rates in competent hands, most women still have the traditional open surgery when hysterectomy is required and usually the stumbling block is the training and choice of their surgeon
I often say to my patients sometimes these laparoscopic procedures may take longer to perform but in the long run the patients benefit from shorter hospital stay and quicker recovery.
Having said this it important to properly select patients for the right procedure.
The best hysterectomy in the absence of prolapse or cancer would be the laparoscopic subtotal hysterectomy with removal of the fallopian tubes and retention of the ovaries.
In women who have had abnormal cervical smears or pelvic pain with or without endometriosis the laparoscopic total hysterectomy would be the best procedure.
For women with pelvic pain and endometriosis when a hysterectomy is required they may also benefit from a total laparoscopic hysterectomy as there are suggestions in medical literature that retaining the cervix may not be a good idea in women with pelvic pain. As if pain persists they may need a second procedure to remove the cervix.
References
EVALUATE hysterectomy trial: a multicentre randomised trial comparing abdominal, vaginal and laparoscopic methods of hysterectomy.
Garry R, Fountain J, Brown J, Manca A, Mason S, Sculpher M, Napp V, Bridgman S, Gray J, Lilford R.
A series of 3190 laparoscopic hysterectomies for benign disease from 1990 to 2006: evaluation of complications compared with vaginal and abdominal procedures
O Donnez*, P Jadoul, J Squifflet, J Donnez