100 LAPAROSCOPIC HYSTERECTOMIES IN PRIVATE-PRACTICE AND VISITING PROFESSORSHIP PROGRAMS

Study Objective. To evaluate 100 laparoscopic hysterectomies and their variations in private practice and visiting professorship programs. D esign. A prospective observational study. Setting. Gynecology departme nts of 17 teaching, community, and proprietary hospitals in the northe astern United States. Patients. One hundred women who successfully und erwent laparoscopic hysterectomy, 91 of whom were followed for 6 month s. Interventions. From July 1990 to August 1994, 108 women (mean age 4 1.6 yrs, range 38-68 yrs) for whom a vaginal hysterectomy was relative ly contraindicated underwent a hysterectomy attempted by the laparosco pic route. The most common indications for hysterectomy were pelvic pa in, chronic menorrhagia, and uterine leiomyomas. The women were classi fied according to hysterectomy, with groups comparable in age, weight, uterine size and weight, concomitant surgery performed, uterine and c oexisting pathology, and history oi pelvic surgery. Of the 108 women, 35 had laparoscopic hysterectomies (LH), 56 had laparoscopic-assisted vaginal hysterectomies (LAVH), and 9 had subtotal laparoscopic hystere ctomies (SLH). Eight procedures were converted to laparotomy, two atte mpted LHs and six attempted LAVHs. In 22 cases, bipolar coagulation of vascular pedicles was done exclusively, in 58 the Endo GIA 30 stapler was used exclusively, and in 20 a combination of both modalities was used. Bilateral ureteral catheters were inserted 49 times. Measurement s and Main Results. There were eight complications (8.0%): two blood t ransfusions, two cases of transient, asymptomatic pyrexia, two abdomin al wall hematomas, one Richter hernia, and one urinary tract infection . The hernia repair was the only delayed laparotomy. The mean (+/-SEM) surgical time was 123 +/- 8 minutes (range 45-235 min), and the mean hospital stay was 1.48 days +/- 0.4 (range 1-5 days). Ninety-five of t he 100 women who successfully underwent a laparoscopic procedure retur ned to work within 2 weeks (range 4-14 days, range 15-53 days for the remaining 5). Conclusion. Hysterectomy performed or aided by the lapar oscope, whether LH, LAVH, or SLH, is effective and sale as long as at least one member of the surgical team is an experienced and appropriat ely trained laparoscopic surgeon. Further studies are necessary to det ermine lithe credentialing process for advanced laparoscopic surgery w ould be facilitated by a visiting professorship program.