title: Perioperative outcomes after total laparoscopic hysterectomy compared with fast-track open hysterectomy - a retrospective case-control study.
abstract: OBJECTIVE
  To examine perioperative outcomes after total laparoscopic hysterectomy compared with fast-track open hysterectomy using a retrospective case-control study.
  
  
  METHODS
  Consecutive cases of total laparoscopic hysterectomy (TLH) carried out by a single surgeon were matched with cases of fast-track open hysterectomy (FTOH) carried out by a second surgeon. Women were matched for age, body mass index, European Cooperative Oncology Group performance status, benign or malignant disease and extent of surgery.
  
  
  RESULTS
  Fifty women were included in each group; women undergoing TLH had a shorter hospital inpatient length of stay (LOS) (1.82 vs 2.62 days, P = 0.02), but longer total theatre time (TT) and surgical time (ST) (226 vs 182 min, P = 0.05; 172 vs 137 min, P = 0.04). LOS, TT and OT were shorter in the second 25 women undergoing TLH than the first 25 cases (1.8 days vs 2.6 days (P = 0.02); 137 min vs 173 min (P = 0.04); 200 min vs 226 min (P = 0.05). A comparison of the second 25 women undergoing TLH with the matched cohort undergoing FTOH revealed a shorter LOS, but no difference in TT or ST (1.8 days vs 3.4 days (P < 0.001); 175 min vs 200 min (P = 0.33); 137 min vs 144 min (P = 0.48)). There were no readmissions in the TLH group and two in the FTOH group, one for a wound infection and another for a small bowel obstruction.
  
  
  CONCLUSIONS
  A TLH results in significantly shorter inpatient stay than FTOH and after an initial learning curve does not result in prolonged theatre or surgical times.
authors.affiliation: The Sydney Gynaecologic Oncology Group, Sydney Cancer Centre, Royal Prince Alfred Hospital, New South Wales, Australia. spather@med.usyd.edu.au
authors.forename: Selvan
authors.initials: S
authors.lastname: Pather
authors.forename: John A
authors.initials: JA
authors.lastname: Loadsman
authors.forename: Claire
authors.initials: C
authors.lastname: Mansfield
authors.forename: Archana
authors.initials: A
authors.lastname: Rao
authors.forename: Vivek
authors.initials: V
authors.lastname: Arora
authors.forename: Shannon
authors.initials: S
authors.lastname: Philp
authors.forename: Jonathan
authors.initials: J
authors.lastname: Carter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy; D007902:Length of Stay; D008875:Middle Aged; D010359:Patient Readmission; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome