A RANDOMIZED PROSPECTIVE TRIAL COMPARING LAPAROSCOPIC AND ABDOMINAL HYSTERECTOMY

Objective To compare short term clinical results in a prospective rand omised trial of laparoscopic hysterectomy compared with abdominal hyst erectomy. Methods One hundred and forty-three women scheduled for tota l abdominal hysterectomy, with or without salpingo-oophorectomy and wi th a maximum uterine width of less than 11 cm, were prospectively rand omised 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 liga ments were transected laparoscopically. The perioperative and post-ope rative courses of the groups were compared. Results The number of wome n with a complication did not differ significantly between laparoscopi c hysterectomy (27%) and abdominal hysterectomy (33%) groups. The post -operative fall in erythrocyte volume fraction was significantly great er following abdominal hysterectomy (5.6% compared with 4.1% median va lue, P < 0.001). Post-operative pain, assessed by the patients two day s after surgery on a visual analogue scale, was significantly higher f ollowing abdominal hysterectomy (4.2 compared with 36 units median val ue, P < 0.05). Although laparoscopic hysterectomy took longer (148 min compared with 85 min median value, P < 0.001), the women undergoing t his procedure had a shorter post-operative time in hospital (two compa red with four days median value, P < 0.001) and a shorter convalescenc e (16 compared with 35 days median value, P < 0.001). Conclusions Lapa roscopic hysterectomy is a safe procedure for selected patients schedu led for abdominal hysterectomy, and offers benefits to the patients in the form of less operative bleeding, less post-operative pain, shorte r time in hospital and shorter convalescence time.