Minimal invasive laparoscopic hysterectomy with ultrasonic scalpel

Background: The purpose of the study was to assess whether total laparoscop ic hysterectomy with the ultrasonic scalpel offers advantages in term of in traoperative and postoperative outcomes over the conventional abdominal hys terectomy. Methods: A case-control study to compare patients undergoing total laparosc opic hysterectomy and women undergoing abdominal hysterectomy for benign co nditions was designed. Matching criteria were the menopausal status, the ne ed of adnexectomy, and the uterus weight. The laparoscopic procedure was ca rried out using an ultrasonically activated scalpel and the amputated uteru s was removed transvaginally. Every part of the operation was carried out v ia laparoscopy, from the adnexal phase to the colpotomy. Abdominal hysterec tomy was performed using a conventional laparotomic technique. Intraoperati ve and postoperative characteristics were analyzed. Results: One hundred forty-four patients were enrolled. of whom 48 underwen t total laparoscopic hysterectomy and 98 abdominal hysterectomy. No differe nce was found between groups in terms of operating time or intraoperative a nd postoperative infectious and noninfectious complications. The median (ra nge) total consumption of morphine (0 mg [0 to 16] versus 15 mg [0 to 100], P < 0.01) during the first 3 postoperative days was significantly lower in the laparoscopic group than in the laparotomic group. The median (range) t ime to regular diet (I[0 to 4] versus 2 [0 to 5]. P < 0.05) and the time to passage of stool (1[1 to 2] versus 2 [1 to 5], P < 0.05) was shorter in th e laparoscopic than in the laparotomic group. Conclusions: Total laparoscopic hysterectomy with the ultrasonic scalpel is feasible and safe, and offers not only cosmetic benefits but also reduces the need of analgesia and the time to return to a normal gastrointestinal f unction in comparison with the conventional abdominal hysterectomy. (C) 200 1 Excerpta Medica, Inc. All rights reserved.