A randomised prospective trial comparing laparoscopic and abdominal hysterectomy

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Abstract
Objective To compare short term clinical results in a prospective randomised trial of laparoscopic hysterectomy compared with abdominal hysterectomy.Methods One hundred and forty‐three women scheduled for total abdominal hysterectomy, with or without salpingo‐oophorectomy and with a maximum uterine width of less than 11 cm, were prospectively randomised to undergo the procedure by laparoscopic hysterectomy (n= 71) or abdominal hysterectomy (n= 72). During laparoscopic hysterectomy, the uterine arteries as well as the upper portion of the cardinal ligaments were transected laparoscopically. The perioperative and post‐operative courses of the groups were compared.Results The number of women with a complication did not differ significantly between laparoscopic hysterectomy (27%) and abdominal hysterectomy (33 %) groups. The post‐operative fall in erythrocyte volume fraction was significantly greater following abdominal hysterectomy (5.6% compared with 4.1 % median value, P 0.001). Post‐operative pain, assessed by the patients two days after surgery on a visual analogue scale, was significantly higher following abdominal hysterectomy (4.2 compared with 3.6 units median value, P < 0.05). Although laparoscopic hysterectomy took longer (148 min compared with 85 min median value, P < 0.001), the women undergoing this procedure had a shorter post‐operative time in hospital (two compared with four days median value, P < 0.001) and a shorter convalescence (16 compared with 35 days median value, P < 0.001).Conclusions Laparoscopic hysterectomy is a safe procedure for selected patients scheduled for abdominal hysterectomy, and offers benefits to the patients in the form of less operative bleeding, less post‐operative pain, shorter time in hospital and shorter convalescence time.

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