Öz
Aim: Our aim is to retrospectively compare the results of total laparoscopic hysterectomy and total abdominal hysterectomy operations performed in benign indications in light of the literature.
Materials and Methods: The records of 240 patients who underwent total hysterectomy for benign indications between July 2015 and October 2020 in the Gynecology and Obstetrics Clinic of Antalya Serik State Hospital were reviewed retrospectively .The age range was 40-75 years and 120 were classified as total laparoscopic hysterectomy (TLH group1) and 120 were classified as total abdominal hysterectomy (TAH Group2). Those with malignancy, post-cesarean hysterectomies, supracervical hysterectomy, laparoscopic
assisted vaginal hysterectomy, and vaginal hysterectomy, those with missing records were excluded
from the study. The mean age, parity, body mass index, mean weight of the removed uterus, history of
previous abdominal surgery, hysterectomy indications, operation time, complication rates, amount of
blood loss, and postoperative hospital stay of the patients were compared between the two groups.
Results: There was no statistical difference between the groups regarding demographic
characteristics. The most common indications in both groups were fibromyoma, treatment resistant
abnormal uterine bleeding. In group 1, the mean operation time was longer but the mean hospital stay
was shorter than group 2, and both were statistically significant. The postoperative mean uterine
weight was heavier in group 2 than in group 1.
Conclusion: Laparoscopic hysterectomy is a safe and convenient minimally invasive surgical
procedure for selected patients, with a longer operation time and requiring experience. It has the
advantage of faster recovery, earlier discharge, and less blood loss.
Anahtar Kelimeler
Kaynakça
- ACOG Committee Opinion No. 444: choosing the route of hysterectomy for benign disease. Obstetrics and gynecology. 2009; 114 (5): 1156-8.
- Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. The Cochrane database of systematic reviews. 2009 (8): Cd003677
- AAGL position statement: route of hysterectomy to treat benign uterine disease. Journal of minimally invasive gynecology. 2011; 18 (1): 1-3.
- David-Montefiore E, Rouzier R, Chapron C, Daraï E. Surgical routes and complications of hysterectomy for benign disorders: a prospective observational study in French university hospitals. Human reproduction (Oxford, England). 2007; 22 (1): 260-5.
- Reich H, DeCaprio J, McGlynn F. Laparoscopic Hysterectomy. Journal of Gynecologic Surgery. 1989; 5 (2): 213-6.
- Johnson N, Barlow D, Lethaby A, Tavender E, Curr E, Garry R. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2006; 19: CD003677
- Mereu L, Carlin R, Pellegrini A, Guasina F, Berlanda V, Tateo S. Total laparoscopic hysterectomy for benign disease: outcomes and literature analysis. Gynecological Surgery. 2018; 15 (1): 19.
- Yada-Hashimoto N, Onoue M, Yoshimi K, Hisa T, Kodama M, Otsuka H, et al. Total laparoscopic hysterectomy in patients with previous abdominal surgery. Archives of gynecology and obstetrics. 2011; 284 (6): 1467-71.
- Donnez O, Donnez J. A series of 400 laparoscopic hysterectomies for benign disease: a single centre, single surgeon prospective study of complications confirming previous retrospective study. BJOG: an international journal of obstetrics and gynaecology. 2010; 117 (6): 752-5.
- King CR, Giles D. Total Laparoscopic Hysterectomy and Laparoscopic-Assisted Vaginal Hysterectomy. Obstetrics and gynecology clinics of North America. 2016; 43 (3): 463-78.
- Candiani M, Izzo S, Bulfoni A, Riparini J, Ronzoni S, Marconi A. Laparoscopic vs vaginal hysterectomy for benign pathology. American journal of obstetrics and gynecology. 2009; 200 (4): 368.e1-7.
- Morelli M, Caruso M, Noia R, Chiodo D, Cosco C, Lucia E, et al. [Total laparoscopic hysterectomy versus vaginal hysterectomy: a prospective randomized trial]. Minerva ginecologica. 2007; 59 (2): 99-105.
- Phipps A, Cucinella G, Venezia R, Castelli A, Cittadini E. Total laparoscopic hysterectomy versus total abdominal hysterectomy: an assessment of the learning curve in a prospective randomized study. Hum Reprod. 1999; 14 (12): 2996-9.
- Garry R, Fountain J, Mason S, Hawe J, Napp V, Abbott J, et al. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ (Clinical research ed). 2004; 328 (7432): 129.
- Leung SW, Chan CS, Lo SFL, Pang CP, Pun TC, Yuen PM. Comparison of the different types of laparoscopic total hysterectomy”. Journal of minimally invasive gynecology. 2007; 14 (1): 91-6.
- Härkki-Sirén P, Sjöberg J, Toivonen J, Tiitinen A. Clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy: a randomized controlled study. Acta Obstet Gynecol Scand. 2000; 79: 86.
- Howard FM, Sanchez R. A comparison of laparoscopic assisted vaginal hysterectomy and abdominal hysterectomy. J Gynecol Surg. 1993; 9 (2): 83-90.
- Seracchioli R, Venturoli S, Vianello F, Govoni F, Cantarelli M, Gualerzi B, et al. Total laparoscopic hysterectomy compared with abdominal hysterectomy in the presence of a large uterus. J Am Ass Gynecol Laparosc. 2002; 9: 333–8.
- Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R. Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ 2005; 330: 1478.
- Mäkinen J, Johansson J, Tomas C, Tomas E, Heinonen PK, Laatikainen T, et al. Morbidity of 10 110 hysterectomies by type of approach. Hum Reprod 2001; 16: 1473-8.
- Härkki-Siren P, Sjöberg J, Kurki T. Major complications of laparoscopy: a follow-up Finnish study. Obstet Gynecol. 1999 Jul;94(1):94–8.
- Wong JMK, Bortoletto P, Tolentino J, Jung MJ, Milad MP. UrinaryTractInjury in Gynecologic Laparoscopy for Benign Indication: A Systematic Review. Obstet Gynecol 2018; 131: 100-8.
- Shen CC, Lu HM, Chang SY. Characteristics and management of large bowel injury in laparoscopic assisted vaginal hysterectomy. J Am Assoc Gynecol Laparosc 2009; 9: 35-9.
- Blikkendaal MD, Twijnstra AR, Pacquee SC, Rhemrev JP, Smeets MJ, de Kroon CD et al. Vaginal cuff dehiscence in laparoscopic hysterectomy: influence of various suturing methods of the vaginal vault. Gynecol Surg 2012; 9: 393-400.
- Olsson JH, Ellstro¨m M, Hahlin M. A randomized prospective trial comparing laparoscopic and abdominal hysterectomy. Br J Obstet Gynaecol. 1996;103:345–50.
- Shveiky D, Aseff JN, Iglesia CB. Brachial plexus injury after laparoscopic and roboticsurgery. J Minim Invasive Gynecol 2010: 17; 414–420.
Öz
Amaç: Amacımız, benign endikasyonlarda yapılan total laparoskopik histerektomi ve total abdominal histerektomi operasyonlarının sonuçlarını literatür eşliğinde retrospektif olarak karşılaştırmaktır.
Gereç ve Yöntem: Antalya Serik Devlet Hastanesi Kadın Hastalıkları ve Doğum Kliniğinde Temmuz 2015 ve Ekim 2020 yılları arasında benign endikasyonlarda total histerektomi uygulanan 240 hastanın kayıtları literatür eşliğinde retrospektif olarak incelendi. Yaş aralığı 40-75 idi. Vakaların 120‘si total laparoskopik histerektomi (TLH Grup1) ve 120‘si total abdominal histerektomi (TAH Grup2) olarak sınıflandırıldı. Malignitesi olanlar, sezaryen sonrası histerektomiler, supraservikal histerektomi, laparoskopik asiste vajinal histerektomi, vajinal histerektomi yapılanlar ve kayıtları eksik olanlar çalışma dışı bırakıldı. Hastalardan operasyon öncesi yazılı onam formu alındı. Hastaların ortalama yaşı, parite, vücut kitle indeksi, çıkarılan ortalama uterus ağırlığı, geçirilmiş batın cerrahisi öyküsü, histerektomi endikasyonları, operasyon süresi, komplikasyon oranları, kan kaybı miktarı, post operatif hastanede yatış süresi iki grup arasında karşılaştırıldı.
Bulgular: İki grup arasında demografik özellikler açısından, istatiksel olarak anlamlı fark yoktu. İki grupta da en sık saptanan endikasyonlar, fibromiyom ve tedaviye dirençli anormal uterin kanamaydı. grup 1’de ortalama ameliyat süresi grup 2 ye göre daha uzun olup istatiksel açıdan anlamlı bulundu. grup 1’de ortalama hastanede kalma süresi daha kısa saptandı ve istatiksel açıdan anlamlı bulundu. Operasyonla çıkarılan ortalama uterus ağırlığı grup 2 de daha ağır saptandı.
Sonuç: Laparoskopik histerektomi, seçilmiş hastalar için operasyon süresinin daha uzun olması ve tecrübe gerektirmesi ile birlikte güvenli ve uygun bir minimal invaziv cerrahi işlemdir. Daha çabuk iyileşme, daha erken taburcu olma, daha az kan kaybı avantajı vardır.
Anahtar Kelimeler
Kaynakça
- ACOG Committee Opinion No. 444: choosing the route of hysterectomy for benign disease. Obstetrics and gynecology. 2009; 114 (5): 1156-8.
- Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. The Cochrane database of systematic reviews. 2009 (8): Cd003677
- AAGL position statement: route of hysterectomy to treat benign uterine disease. Journal of minimally invasive gynecology. 2011; 18 (1): 1-3.
- David-Montefiore E, Rouzier R, Chapron C, Daraï E. Surgical routes and complications of hysterectomy for benign disorders: a prospective observational study in French university hospitals. Human reproduction (Oxford, England). 2007; 22 (1): 260-5.
- Reich H, DeCaprio J, McGlynn F. Laparoscopic Hysterectomy. Journal of Gynecologic Surgery. 1989; 5 (2): 213-6.
- Johnson N, Barlow D, Lethaby A, Tavender E, Curr E, Garry R. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2006; 19: CD003677
- Mereu L, Carlin R, Pellegrini A, Guasina F, Berlanda V, Tateo S. Total laparoscopic hysterectomy for benign disease: outcomes and literature analysis. Gynecological Surgery. 2018; 15 (1): 19.
- Yada-Hashimoto N, Onoue M, Yoshimi K, Hisa T, Kodama M, Otsuka H, et al. Total laparoscopic hysterectomy in patients with previous abdominal surgery. Archives of gynecology and obstetrics. 2011; 284 (6): 1467-71.
- Donnez O, Donnez J. A series of 400 laparoscopic hysterectomies for benign disease: a single centre, single surgeon prospective study of complications confirming previous retrospective study. BJOG: an international journal of obstetrics and gynaecology. 2010; 117 (6): 752-5.
- King CR, Giles D. Total Laparoscopic Hysterectomy and Laparoscopic-Assisted Vaginal Hysterectomy. Obstetrics and gynecology clinics of North America. 2016; 43 (3): 463-78.
- Candiani M, Izzo S, Bulfoni A, Riparini J, Ronzoni S, Marconi A. Laparoscopic vs vaginal hysterectomy for benign pathology. American journal of obstetrics and gynecology. 2009; 200 (4): 368.e1-7.
- Morelli M, Caruso M, Noia R, Chiodo D, Cosco C, Lucia E, et al. [Total laparoscopic hysterectomy versus vaginal hysterectomy: a prospective randomized trial]. Minerva ginecologica. 2007; 59 (2): 99-105.
- Phipps A, Cucinella G, Venezia R, Castelli A, Cittadini E. Total laparoscopic hysterectomy versus total abdominal hysterectomy: an assessment of the learning curve in a prospective randomized study. Hum Reprod. 1999; 14 (12): 2996-9.
- Garry R, Fountain J, Mason S, Hawe J, Napp V, Abbott J, et al. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ (Clinical research ed). 2004; 328 (7432): 129.
- Leung SW, Chan CS, Lo SFL, Pang CP, Pun TC, Yuen PM. Comparison of the different types of laparoscopic total hysterectomy”. Journal of minimally invasive gynecology. 2007; 14 (1): 91-6.
- Härkki-Sirén P, Sjöberg J, Toivonen J, Tiitinen A. Clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy: a randomized controlled study. Acta Obstet Gynecol Scand. 2000; 79: 86.
- Howard FM, Sanchez R. A comparison of laparoscopic assisted vaginal hysterectomy and abdominal hysterectomy. J Gynecol Surg. 1993; 9 (2): 83-90.
- Seracchioli R, Venturoli S, Vianello F, Govoni F, Cantarelli M, Gualerzi B, et al. Total laparoscopic hysterectomy compared with abdominal hysterectomy in the presence of a large uterus. J Am Ass Gynecol Laparosc. 2002; 9: 333–8.
- Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R. Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ 2005; 330: 1478.
- Mäkinen J, Johansson J, Tomas C, Tomas E, Heinonen PK, Laatikainen T, et al. Morbidity of 10 110 hysterectomies by type of approach. Hum Reprod 2001; 16: 1473-8.
- Härkki-Siren P, Sjöberg J, Kurki T. Major complications of laparoscopy: a follow-up Finnish study. Obstet Gynecol. 1999 Jul;94(1):94–8.
- Wong JMK, Bortoletto P, Tolentino J, Jung MJ, Milad MP. UrinaryTractInjury in Gynecologic Laparoscopy for Benign Indication: A Systematic Review. Obstet Gynecol 2018; 131: 100-8.
- Shen CC, Lu HM, Chang SY. Characteristics and management of large bowel injury in laparoscopic assisted vaginal hysterectomy. J Am Assoc Gynecol Laparosc 2009; 9: 35-9.
- Blikkendaal MD, Twijnstra AR, Pacquee SC, Rhemrev JP, Smeets MJ, de Kroon CD et al. Vaginal cuff dehiscence in laparoscopic hysterectomy: influence of various suturing methods of the vaginal vault. Gynecol Surg 2012; 9: 393-400.
- Olsson JH, Ellstro¨m M, Hahlin M. A randomized prospective trial comparing laparoscopic and abdominal hysterectomy. Br J Obstet Gynaecol. 1996;103:345–50.
- Shveiky D, Aseff JN, Iglesia CB. Brachial plexus injury after laparoscopic and roboticsurgery. J Minim Invasive Gynecol 2010: 17; 414–420.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Aralık 2022 |
| Gönderilme Tarihi | 10 Mart 2022 |
| Yayımlandığı Sayı | Yıl 2022Cilt: 61 Sayı: 4 |
