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Safe total intrafascial laparoscopic (TAIL) hysterectomy: a prospective cohort study.

Hohl MK, Hauser N - Gynecol Surg (2010)

Bottom Line: The operation times are comparable for all three techniques without any statistically significant differences.This technique for laparoscopic hysterectomy is shown to be equally safe when applied by experienced gynaecologic surgeons or by residents in training.ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10397-010-0569-0) contains supplementary material, which is available to authorized users.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Kantonsspital Baden, CH-5404 Baden, Switzerland.

ABSTRACT
This study directly compares total intrafascial laparoscopic (TAIL) hysterectomy with vaginal (VH) and abdominal (AH) hysterectomy with regard to safety, operating time and time of convalescence. The study is a prospective cohort study (Canadian Task Force classification II-2), including data from patients of a single university-affiliated teaching institution, admitted between 1997 and 2008 for hysterectomy due to benign uterus pathology. Patient data were collected pre-, intra- and postoperatively and complications documented using a standardised data sheet of a Swiss obstetric and gynaecological study group (Arbeitsgemeinschaft Schweizerische Frauenkliniken, Amlikon/Switzerland). Classification of complications (major complications and minor complications) for all three operation techniques, evaluation of surgeons and comparison of operation times and days of hospitalisation were analysed. 3066 patients were included in this study. 993 patients underwent AH, 642 VH and 1,431 total intrafascial hysterectomy. No statistically significant difference for the operation times comparing the three groups can be demonstrated. The mean hospital stay in the TAIL hysterectomy, VH and AH groups is 5.8 +/- 2.4, 8.8 +/- 4.0 and 10.4 +/- 3.9 days, respectively. The postoperative minor complications including infection rates are low in the TAIL hysterectomy group (3.8%) when compared with either the AH group (15.3%) or the VH group (11.2%), respectively. The total of minor complications is statistically significant lower for TAIL hysterectomy as for AH (O.R. 4.52, CI 3.25-6.31) or VH (O.R. 3.16, CI 2.16-4.62). Major haemorrhage with consecutive reoperation is observed statistically significantly more frequent in the AH group when compared to the TAIL hysterectomy group, with an O.R. of 6.13 (CI 3.05-12.62). Overall, major intra- and postoperative complications occur significant more frequently in the AH group (8.6%) when compared to the VH group (3%) and the TAIL hysterectomy group (1.8%). The incidence of major complications applying the standardised TAIL hysterectomy technique is not related to the experience of the surgeons. We conclude that a standardised intrafascial technique of total laparoscopic (TAIL) hysterectomy using an anatomically developed special uterine device is associated with a very low incidence of minor and major intra- and postoperative complications. The direct comparison of complication rates with either vaginal or abdominal hysterectomy favours the total laparoscopic technique, and therefore, this technique can be recommended as a relatively atraumatic procedure. The operation times are comparable for all three techniques without any statistically significant differences. This technique for laparoscopic hysterectomy is shown to be equally safe when applied by experienced gynaecologic surgeons or by residents in training. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10397-010-0569-0) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus

Application of the uterine device
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Fig2: Application of the uterine device

Mentions: The patient is positioned in laparoscopic dorsal lithotomy position. Buttocks have to be positioned on the lower edge of the operation table to allow free manipulation with the instrument in all directions. The patient’s position is maintained by the use of shoulder supports and in recent years by special retraining mattresses on the operation table. Cranial sliding even in deep Trendelenburg position is thus mostly prevented. A tenaculum is placed on the anterior lip of the cervix and the cervix is dilated to Hegar 6. The length of the uterus cavity is measured. The size of the spiral thread is chosen according to the dimensions of the cervical canal (wide or narrow) and Hegar-type rod extensions according to uterine cavity length. Then, spiral threads are very tightly screwed into the endocervix to move even large uteri in all directions and apply strong tension to the tissues. The manipulator handpiece with an attached cup is gently introduced into the vagina with light rotating movements (Fig. 2). It has to be ensured that the extended side of the manipulator cup is located dorsally. Only after the manipulator handpiece has been advanced cranially as far as possible it is screwed to the manipulator probe. As a result, the edge of the manipulator cup is exactly located at the boundary of the cervix and the vagina (Video 1).Fig. 2


Safe total intrafascial laparoscopic (TAIL) hysterectomy: a prospective cohort study.

Hohl MK, Hauser N - Gynecol Surg (2010)

Application of the uterine device
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2914872&req=5

Fig2: Application of the uterine device
Mentions: The patient is positioned in laparoscopic dorsal lithotomy position. Buttocks have to be positioned on the lower edge of the operation table to allow free manipulation with the instrument in all directions. The patient’s position is maintained by the use of shoulder supports and in recent years by special retraining mattresses on the operation table. Cranial sliding even in deep Trendelenburg position is thus mostly prevented. A tenaculum is placed on the anterior lip of the cervix and the cervix is dilated to Hegar 6. The length of the uterus cavity is measured. The size of the spiral thread is chosen according to the dimensions of the cervical canal (wide or narrow) and Hegar-type rod extensions according to uterine cavity length. Then, spiral threads are very tightly screwed into the endocervix to move even large uteri in all directions and apply strong tension to the tissues. The manipulator handpiece with an attached cup is gently introduced into the vagina with light rotating movements (Fig. 2). It has to be ensured that the extended side of the manipulator cup is located dorsally. Only after the manipulator handpiece has been advanced cranially as far as possible it is screwed to the manipulator probe. As a result, the edge of the manipulator cup is exactly located at the boundary of the cervix and the vagina (Video 1).Fig. 2

Bottom Line: The operation times are comparable for all three techniques without any statistically significant differences.This technique for laparoscopic hysterectomy is shown to be equally safe when applied by experienced gynaecologic surgeons or by residents in training.ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10397-010-0569-0) contains supplementary material, which is available to authorized users.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Kantonsspital Baden, CH-5404 Baden, Switzerland.

ABSTRACT
This study directly compares total intrafascial laparoscopic (TAIL) hysterectomy with vaginal (VH) and abdominal (AH) hysterectomy with regard to safety, operating time and time of convalescence. The study is a prospective cohort study (Canadian Task Force classification II-2), including data from patients of a single university-affiliated teaching institution, admitted between 1997 and 2008 for hysterectomy due to benign uterus pathology. Patient data were collected pre-, intra- and postoperatively and complications documented using a standardised data sheet of a Swiss obstetric and gynaecological study group (Arbeitsgemeinschaft Schweizerische Frauenkliniken, Amlikon/Switzerland). Classification of complications (major complications and minor complications) for all three operation techniques, evaluation of surgeons and comparison of operation times and days of hospitalisation were analysed. 3066 patients were included in this study. 993 patients underwent AH, 642 VH and 1,431 total intrafascial hysterectomy. No statistically significant difference for the operation times comparing the three groups can be demonstrated. The mean hospital stay in the TAIL hysterectomy, VH and AH groups is 5.8 +/- 2.4, 8.8 +/- 4.0 and 10.4 +/- 3.9 days, respectively. The postoperative minor complications including infection rates are low in the TAIL hysterectomy group (3.8%) when compared with either the AH group (15.3%) or the VH group (11.2%), respectively. The total of minor complications is statistically significant lower for TAIL hysterectomy as for AH (O.R. 4.52, CI 3.25-6.31) or VH (O.R. 3.16, CI 2.16-4.62). Major haemorrhage with consecutive reoperation is observed statistically significantly more frequent in the AH group when compared to the TAIL hysterectomy group, with an O.R. of 6.13 (CI 3.05-12.62). Overall, major intra- and postoperative complications occur significant more frequently in the AH group (8.6%) when compared to the VH group (3%) and the TAIL hysterectomy group (1.8%). The incidence of major complications applying the standardised TAIL hysterectomy technique is not related to the experience of the surgeons. We conclude that a standardised intrafascial technique of total laparoscopic (TAIL) hysterectomy using an anatomically developed special uterine device is associated with a very low incidence of minor and major intra- and postoperative complications. The direct comparison of complication rates with either vaginal or abdominal hysterectomy favours the total laparoscopic technique, and therefore, this technique can be recommended as a relatively atraumatic procedure. The operation times are comparable for all three techniques without any statistically significant differences. This technique for laparoscopic hysterectomy is shown to be equally safe when applied by experienced gynaecologic surgeons or by residents in training. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10397-010-0569-0) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus