Quality of life and surgical outcome after total laparoscopic hysterectomy versus total abdominal hysterectomy for benign disease: a randomized, controlled trial.
OBJECTIVE
Minimally invasive surgery aims to achieve at least a similar clinical effectiveness with a quicker recovery than traditional open techniques. Although there have been numerous randomized clinical trials comparing laparoscopic hysterectomy with hysterectomy by laparotomy, only a few studies have compared quality of life after different types of hysterectomy. None of these studies evaluated total laparoscopic hysterectomy. In this paper, we report on a randomized comparison of quality of life after total laparoscopic versus total abdominal hysterectomy.


METHODS
Randomized, controlled trial (Canadian Task Force classification I).


METHODS
Single-center teaching hospital in The Netherlands.


METHODS
Patients scheduled for hysterectomy for a benign condition, in whom a vaginal hysterectomy was not possible and laparoscopic hysterectomy was feasible (mobile uterus not exceeding the size of 18 weeks' gestation).


METHODS
Abdominal versus laparoscopic hysterectomy.


RESULTS
Patients completed the Dutch version RAND-36 health survey preoperatively as well as at 5 time points in the first 12 weeks after surgery. The primary outcome of the study was quality of life as measured by the RAND-36. A linear mixed model was used for statistical analysis while accounting for baseline values. Secondary outcomes were hospital stay and complications. There were 88 patients eligible, of whom 59 gave consent for randomization. Twenty-seven women were allocated to the laparoscopic arm and 32 to the abdominal arm. We found a significant treatment effect favoring laparoscopic hysterectomy in the RAND-36 scale for vitality. Laparoscopic hysterectomy performed better on all other scales of the RAND-36, but these differences were not statistically significant.


CONCLUSIONS
Laparoscopic hysterectomy results in more postoperative vitality when compared with abdominal hysterectomy. For this reason, all women with a benign condition requiring abdominal hysterectomy, in whom the laparoscopic approach is feasible, should have the chance to choose laparoscopic hysterectomy.
Kluivers
Kirsten B
KB
Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. k.kluivers@obgyn.umcn.nl
Hendriks
Jan C M
JC
Mol
Ben W J
BW
Bongers
Marlies Y
MY
Bremer
Gerard L
GL
de Vet
Henrica C W
HC
Vierhout
Mark E
ME
Brolmann
Hans A M
HA
D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods* / Q000523:psychology; D010535:Laparoscopy / Q000523:psychology; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000523:psychology; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011788:Quality of Life