Clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy: a randomized controlled study

Background. To evaluate clinical outcome and tissue trauma after laparoscop ic and abdominal hysterectomy. Methods. Fifty women scheduled for abdominal hysterectomy were randomized t o undergo either laparoscopic (n=25) or abdominal (n=25) hysterectomy. Surg ical characteristics, hospital stay, convalescence and complications were a nalyzed. Blood samples for assay of markers of tissue trauma (interleukin-6 , C-reactive protein, tumor-associated trypsin inhibitor and tumor-associat ed antigen CA 125) were taken preoperatively, an the first, second and seve nth postoperative day and at the follow-up visit four weeks after surgery Results. In uncomplicated hysterectomies (n=18) the operating time (85.3 mi n versus 57.5 min, p<0.00001) was longer for laparoscopic group but the hos pital stay (2.1 days versus 3.4 days, p<0.00001) and sick leave (21.4 days versus 38.5 days, p<0.00001) were shorter in the laparoscopic group. Postop erative increases in all markers were significant in both groups. The inter leukin-6 concentration was highest on the first postoperative day in both g roups, that of C-reactive protein on the second postoperative day in both g roups, tumor-associated trypsin inhibitor on the seventh postoperative day in the laparoscopic group and on the second postoperative day in the abdomi nal group and tumor-associated antigen CA 125 on the seventh postoperative day in both groups. Both interleukin-6 and C-reactive protein levels were l ower in the laparoscopic group on the first (p=0.01 and p=0.03, respectivel y) and on the second postoperative day (p=0.02 and p<0.001, respectively) c ompared with the abdominal group. No differences were seen in tumor-associa ted trypsin inhibitor and tumor-associated antigen CA 125 levels between th e groups. Conclusion. Laparoscopic hysterectomy should replace abdominal hysterectomy whenever possible because of a more favorable clinical outcome and less ti ssue trauma.