Clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy: a randomized controlled study.
BACKGROUND
To evaluate clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy.


METHODS
Fifty women scheduled for abdominal hysterectomy were randomized to undergo either laparoscopic (n = 25) or abdominal (n = 25) hysterectomy. Surgical characteristics, hospital stay, convalescence and complications were analyzed. Blood samples for assay of markers of tissue trauma (interleukin-6, C-reactive protein, tumor-associated trypsin inhibitor and tumor-associated antigen CA 125) were taken preoperatively, on the first, second and seventh postoperative day and at the follow-up visit four weeks after surgery.


RESULTS
In uncomplicated hysterectomies (n = 18) the operating time (85.3 min versus 57.5 min, p < 0.00001) was longer for laparoscopic group but the hospital 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. Postoperative increases in all markers were significant in both groups. The interleukin-6 concentration was highest on the first postoperative day in both groups, that of C-reactive protein on the second postoperative day in both groups, tumor-associated trypsin inhibitor on the seventh postoperative day in the laparoscopic group and on the second postoperative day in the abdominal group and tumor-associated antigen CA 125 on the seventh postoperative day in both groups. Both interleukin-6 and C-reactive protein levels were lower in the laparoscopic group on the first (p = 0.01 and p = 0.03, respectively) and on the second postoperative day (p = 0.02 and p < 0.001, respectively) compared with the abdominal group. No differences were seen in tumor-associated trypsin inhibitor and tumor-associated antigen CA 125 levels between the groups.


CONCLUSIONS
Laparoscopic hysterectomy should replace abdominal hysterectomy whenever possible because of a more favorable clinical outcome and less tissue trauma.
Härkki-Sirén
P
P
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Finland.
Sjöberg
J
J
Toivonen
J
J
Tiitinen
A
A
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D018394:CA-125 Antigen / Q000097:blood; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods*; D015850:Interleukin-6 / Q000097:blood; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014359:Trypsin Inhibitor, Kazal Pancreatic / Q000097:blood
D015415:Biomarkers; D018394:CA-125 Antigen; D006454:Hemoglobins; D015850:Interleukin-6; D014359:Trypsin Inhibitor, Kazal Pancreatic; D002097:C-Reactive Protein