Assessment of tissue damage associated with laparoscopic and conventional hysterectomies

Objective To assess and compare damage to tissue during laparoscopic and co nventional hysterectomies. Design Prospective clinical study. Setting Department of Gynaecology, Baby-Friendly Hospital, Kladno, Czech Re public. Subjects 95 women who had undergone laparoscopic, abdominal or vaginal hyst erectomy. Main outcome measures The operative trauma and tissue damage were assessed using the enzymatic activity of creatine kinase (CK). Serum levels of CK we re measured in 85 patients who had undergone hysterectomy, and the activiti es of CK, isoenzyme CK-MB and aspartate aminotransferase (AST) were investi gated in seven patients of an additional group. Results The rate of CK activity was significantly greater in 28 patients wh o underwent abdominal hysterectomy (P < 0.005) compared with that in the pa tients who underwent laparoscopic or vaginal hysterectomies (34 and 23 pati ents, respectively). The CK levels in the latter two groups were also signi ficantly different (P < 0.025). Conclusion Following total abdominal hysterectomy, tissue damage, as assess ed by the activity of creatine kinase, is statistically significantly great er than that following laparoscopic and vaginal hysterectomies. Clinical ex perience and metabolic changes indicate that the perioperative stress in pa tients undergoing laparoscopic hysterectomy is lower than that in patients where an abdominal approach is used. Large prospective studies are needed t o evaluate the surgical trauma and metabolic changes induced by laparoscopi c hysterectomy.