Laparoscopic supracervical hysterectomy (LASH), a retrospective study of 1,584 cases regarding intra- and perioperative complications

Abstract

Objective: The main interest of this study was to assess the rate of intraoperative and perioperative complications of laparoscopic supracervical hysterectomy (LASH) in a teaching hospital.

Methods: A retrospective analysis of 1,584 laparoscopic assisted hysterectomies between 2005 and 2010 by different surgeons.

Results: In 2,577 patients undergoing simple hysterectomy, an indication for LASH was present in 1,584 cases. Indications were uterine myomas (71.6%), dysfunctional uterine bleeding (12.6%), suspicion of adenomyosis uteri (8.9%), descensus uteri (2.8%), dysmenorrhea (2.8%), hysterectomy on demand (1.2%) and benign hyperplasia of the endometrium (0.2%). Mean duration of the procedure was 76.5 ± 33.4 min (95% CI, ± 1.66). The average age of patients was 45.9 ± 5.4 years (95% CI, ± 0.27). Mean body mass index (BMI) was 25.3 ± 4.9 (95% CI, ± 0.24). Adhesiolysis due to earlier surgery had to be performed in 190 (12%) cases. The total complication rate was 1.07%. The total conversion rate to laparotomy was 0.88%. The rate of conversion after laparoscopic assessment of the situs was 0.57%. In five cases, conversion to laparotomy was necessary due to intraoperative complications (0.32%). On the whole, six bleedings (0.38%), four bladder injuries (0.25%), three intestinal injuries (0.19%), one ureter injury (0.06%), one injury of the epigastric vein (0.06%) and two omental incarcerations (0.13%) occurred.

Conclusion: In this retrospective analysis, the rate of complications for LASH was very low in a hospital of standard care and residency. LASH has to be considered as a minimally invasive method with a low perioperative morbidity to treat benign uterine pathologies even in a teaching setting and should therefore be the method of choice if the cervix can be preserved.